Thyroid Abscess: A Very Rare Entity in Child

Thyroid abscess is a very rare clinical entity, but potentially fatal emergency in the pediatric age group, with a mortality of 3.7%-9% in acute suppurative thyroiditis (AST), it is imperative to make a timely diagnosis and start treatment accordingly, it represents 0.1% of surgical pathologies of the thyroid. The anatomical and physiological characteristics of the gland provide it with resistance to pathogens. Recurrence is still exceptional. In this case report, we discuss a rare case of thyroid abscess in a 7-year-old girl revealing a piriform sinus fistula. Through this article, we attempt to stress the need for quick and accurate diagnosis and timely intervention to prevent complications as the condition is rare and unusual. The child presented to the pediatric emergency in January 2023 for a first episode of febrile torticollis the exploration objectified a thyroid abscess treated by probabilistic antibiotic therapy with good clinical and biological evolution, 6 months later, the child consulted again for the same symptomatology with febrile torticollis, dysphagia without signs of dysthyroidism, fever, and night sweats. Cervical computed tomography showed a mass occupying the left thyroid lobe. A cervical ultrasound showed heterogeneous hypoechoic collection; poorly limited. The biological assessment objectified a hyperleukocytosis in 19090 with a predominance of neutrophils with a C-reactive protein at 150 mg/l. The management was medical including intravenous antibiotic therapy based on amoxicillin-clavulanic acid and exploration by nasofibroscopy completed by hypopharyngoscopy showed a fistula of the piriform sinus. The treatment is based on surgery by cauterization of the sinus.