Thyroid abscess associated with thyrotoxicosis caused by Yersinia enterocolitica subsp. palearctica in a patient with follicular adenoma of the thyroid gland

BACKGROUND

Yersinia enterocolitica is a gram-negative zoonotic bacterial pathogen that is typically transmitted via the fecal-oral route. The most common clinical manifestation of a Y. enterocolitica infection is self-limited gastroenteritis. Although various extraintestinal manifestations of Y. enterocolitica infection have been reported, there are no reports of thyroid abscesses.

CASE PRESENTATION

An 89-year-old Japanese man with follicular adenoma of the left thyroid gland was admitted to our hospital with a 2-day history of fever and left neck pain. Laboratory tests revealed low levels of thyroid stimulating hormone and elevated levels of free thyroxine 4. Contrast-enhanced computed tomography showed low-attenuation areas with peripheral enhancement in the left thyroid gland. He was diagnosed with thyroid abscess and thyrotoxicosis, and treatment with intravenous piperacillin-tazobactam was initiated after collecting blood, drainage fluid, and stool samples. The isolated Gram-negative rod bacteria from blood and drainage fluid cultures was confirmed to be Y. enterocolitica. He was diagnosed with thyroid abscess and thyrotoxicosis due to be Y. enterocolitica subsp. palearctica. The piperacillin-tazobactam was replaced with levofloxacin.

CONCLUSION

We report a novel case of a thyroid abscess associated with thyrotoxicosis caused by Y. enterocolitica subsp. palearctica in a patient with a follicular thyroid adenoma.

Acute Suppurative Thyroiditis (AST) With Thyroid Abscess: A Rare and Potentially Fatal Neck Infection

Thyroid abscess, although rare, is a condition that usually occurs as a sequela of acute suppurative thyroiditis (AST) which is an infection of the thyroid gland. The infrequent occurrence of thyroid abscess is due to the unique anatomical and physiological characteristics of the gland which renders it resistant to infections. Delay in diagnosis and treatment can have adverse outcomes and serious complications such as septicaemia, descending necrotising mediastinitis, extension into deep spaces of the neck, and tracheal or oesophageal perforation. The mainstay of management is a combination of systemic antibiotics along with incision and drainage, and rarely surgery. We report the case of a 37-year-old male with acute suppurative thyroiditis with a thyroid abscess. He underwent incision and drainage of the abscess and was subsequently treated with systemic antibiotics. This condition warrants a prompt and timely diagnosis with appropriate management as it often leads to fatal complications if not diagnosed early.