Scientific letter
Thyroid abscess of polymicrobial origin in a child
Absceso tiroideo de origen polimicrobiano en un niño
Evelyn Cervantes-García, César Gavilán-Martín, David Ferrández-Mengual, Ana Pilar Nso-Roca
Corresponding author
Pediatría, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
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"lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X20302032?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X20302069?idApp=UINPBA00004N" "url" => "/2529993X/0000003900000001/v1_202101090634/S2529993X20302069/v1_202101090634/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Thyroid abscess of polymicrobial origin in a child" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "53" "paginaFinal" => "54" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Evelyn Cervantes-García, César Gavilán-Martín, David Ferrández-Mengual, Ana Pilar Nso-Roca" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Evelyn" "apellidos" => "Cervantes-García" ] 1 => array:2 [ "nombre" => "César" "apellidos" => "Gavilán-Martín" ] 2 => array:2 [ "nombre" => "David" "apellidos" => "Ferrández-Mengual" ] 3 => array:4 [ "nombre" => "Ana Pilar" "apellidos" => "Nso-Roca" "email" => array:1 [ 0 => "ananso@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Pediatría, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Absceso tiroideo de origen polimicrobiano en un niño" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 516 "Ancho" => 1250 "Tamanyo" => 72256 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Cervical tumour in the hospitalised patient. B) Collection of heterogeneous echogenicity consistent with a left thyroid abscess measuring 38<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>26<span class="elsevierStyleHsp" style=""></span>mm.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acute suppurative thyroiditis (AST) and thyroid abscess are infectious processes in the thyroid gland that are extremely rare, accounting for 0.7%–1% of all thyroid disorders.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This low prevalence is due to the thyroid gland's intrinsic resistance to bacterial invasion, as a result of both its chemical and its anatomical characteristics.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In most cases, the infection's portal of entry is unknown, but colonisation of a distal region appears to be the most common cause.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–6</span></a> Initial clinical signs are usually non-specific and difficult to detect, with painful inflammation developing in the anterior neck area as the condition progresses. This is a potentially serious condition.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Ultrasound is the first-line imaging technique.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Treatment is based on intravenous broad-spectrum antibiotics aimed at covering germs in the patient's oropharyngeal flora. Fine-needle aspiration biopsy or surgical drainage must be performed if the clinical course demands it.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> With early diagnosis and treatment, the disease usually has a good prognosis. We report a case of acute suppurative thyroiditis complicated by a thyroid abscess.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A previously healthy 3-year-old boy had a fever up to 39.5<span class="elsevierStyleHsp" style=""></span>°C and odynophagia for the past 3 days. He presented with firm, painful swelling of the anterior neck slightly to the left with local erythema (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Blood testing revealed leukocytosis (18<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/l) with neutrophils 74.3% and lymphocytes 15.6%, C-reactive protein (CRP) 11<span class="elsevierStyleHsp" style=""></span>mg/dl and erythrocyte sedimentation rate (ESR) 38<span class="elsevierStyleHsp" style=""></span>mm/h. His thyroid hormone levels and antithyroid antibody levels were normal. An ultrasound of the neck showed enlargement of the thyroid gland at the expense of the left thyroid lobe, with a heterogeneous echostructure and an uneven hypoechoic area consistent with an in trathyroid abscess measuring 12<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm. Given the clinical picture consistent with a thyroid abscess, parenteral antibiotic therapy was administered with amoxycillin/clavulanic acid. After 48<span class="elsevierStyleHsp" style=""></span>h had elapsed since the start of treatment, the patient's fever disappeared and his laboratory test results improved; however, the swollen area on his neck increased in size. A follow-up ultrasound showed that the collection had enlarged up to 38<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>26<span class="elsevierStyleHsp" style=""></span>mm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Given the patient's poor clinical course, percutaneous abscess drainage was performed, yielding 30<span class="elsevierStyleHsp" style=""></span>mL of purulent material. In the days that followed, the patient made good progress with the swelling of his neck and his inflammatory signs gradually disappearing. Microbiological testing isolated <span class="elsevierStyleItalic">Streptococcus con stellatus</span> and <span class="elsevierStyleItalic">Eikenella corrodens</span> which were sensitive to the antibiotic therapy administered. Blood culture was negative. Following 10 days of intravenous antibiotic therapy, the patient was discharged to complete his treatment with oral amoxicillin/clavulanic acid for 11 days. Subsequent clinical monitoring was normal and magnetic resonance imaging (MRI) was performed which ruled out anatomical malformations.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Thyroid abscess is a very rare clinical condition that can occur in the context of acute suppurative thyroiditis, a disease that is unusual in itself.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> It can occur at any age, but it is rare in childhood.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Its clinical presentation is characterised by inflammation and an increase in sensitivity in the anterior region of the neck, accompanied by fever and pharyngeal pain. As the initial signs are subtle, diagnosis is late in most cases.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The left thyroid gland is more commonly affected, since the cause is usually a pyriform sinus fistula and thyroid function is usually normally, as in the case reported.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The initial test of choice is an ultrasound of the thyroid gland. To rule out predisposing anatomical defects, and when retrosternal spread is suspected, a computed tomography (CT) scan, MRI or an oesophagogram is performed. Our case was exceptional because it involved a previously healthy boy with no associated anatomical abnormalities. Ultrasound-guided fine-needle aspiration biopsy is a simple procedure that enables diagnostic confirmation and yields a sample for microbiological testing.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6</span></a> The most commonly found micro-organisms are polymicrobial flora in the oral cavity, due to its anatomical cause. They are often Gram-positive bacteria such as <span class="elsevierStyleItalic">Staphylococcus aureus</span> and <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>. More rarely, Gram-negative pathogens <span class="elsevierStyleItalic">(Escherichia coli, Haemophilus influenzae, Klebsiella, Salmonella)</span>, <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> or fungi may be isolated.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Therapeutic management includes empirical parenteral antibiotic therapy with broad-spectrum antibiotics.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Surgery is indicated if there is any airway compromise or, in a second stage, if a pyriform sinus fistula is found.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Thyroid abscess is therefore very rare and requires strong clinical suspicion and early therapeutic management. Although the clinical course in most cases is benign, it should be considered a medical emergency due to the serious associated complications.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cervantes-García E, Gavilán-Martín C, Ferrández-Mengual D, Nso-Roca AP. Absceso tiroideo de origen polimicrobiano en un ni˜no. Enferm Infecc Microbiol Clin. 2021;39:53–54.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 516 "Ancho" => 1250 "Tamanyo" => 72256 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Cervical tumour in the hospitalised patient. B) Collection of heterogeneous echogenicity consistent with a left thyroid abscess measuring 38<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>26<span class="elsevierStyleHsp" style=""></span>mm.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thyroid abscess in a child" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Srinath" 1 => "K.R. Suma" 2 => "G.V. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 9 | 0 | 9 |
| 2024 September | 50 | 3 | 53 |
| 2024 August | 38 | 2 | 40 |
| 2024 July | 23 | 3 | 26 |
| 2024 June | 14 | 3 | 17 |
| 2024 May | 14 | 3 | 17 |
| 2024 April | 12 | 47 | 59 |
| 2024 March | 15 | 4 | 19 |
| 2024 February | 18 | 1 | 19 |
| 2024 January | 25 | 1 | 26 |
| 2023 December | 23 | 3 | 26 |
| 2023 November | 9 | 4 | 13 |
| 2023 October | 15 | 1 | 16 |
| 2023 September | 5 | 0 | 5 |
| 2023 August | 7 | 2 | 9 |
| 2023 July | 7 | 2 | 9 |
| 2023 June | 9 | 1 | 10 |
| 2023 May | 16 | 3 | 19 |
| 2023 April | 34 | 0 | 34 |
| 2023 March | 31 | 1 | 32 |
| 2023 February | 14 | 1 | 15 |
| 2023 January | 35 | 8 | 43 |
| 2022 December | 22 | 3 | 25 |
| 2022 November | 18 | 2 | 20 |
| 2022 October | 9 | 5 | 14 |
| 2022 September | 7 | 5 | 12 |
| 2022 August | 8 | 11 | 19 |
| 2022 July | 11 | 9 | 20 |
| 2022 June | 7 | 3 | 10 |
| 2022 May | 11 | 5 | 16 |
| 2022 April | 7 | 4 | 11 |
| 2022 March | 6 | 9 | 15 |
| 2022 February | 12 | 6 | 18 |
| 2022 January | 12 | 3 | 15 |
| 2021 December | 9 | 11 | 20 |
| 2021 November | 10 | 13 | 23 |
| 2021 October | 16 | 13 | 29 |
| 2021 September | 7 | 5 | 12 |
| 2021 August | 7 | 5 | 12 |
| 2021 July | 6 | 1 | 7 |
| 2021 April | 1 | 0 | 1 |
| 2021 January | 2 | 2 | 4 |
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