Acute Bacterial Suppurative Thyroiditis following Fine Needle Aspiration: A Case Report and Review of the Literature

Abstract

Background. Fine needle aspiration (FNA) of thyroid nodules is a simple, reliable, and inexpensive procedure performed on suspicious thyroid nodules found in thyroid ultrasound (US). Acute bacterial suppurative thyroiditis is an uncommon complication of FNA which, however, can be life threatening. Case Presentation. A 49-year-old lady presented with fever and neck pain 1 month after FNA with biochemical evidence of thyrotoxicosis. Repeat US of the thyroid showed interval enlargement of the thyroid nodule, and the culture of the cystic fluid of repeat FNA grew Propionibacterium acnes. She responded well to bedside aspiration and 2 weeks of antibiotic therapy without requiring surgical intervention. Discussion. Acute bacterial suppurative thyroiditis following FNA has been increasingly reported in immunocompetent hosts. There are 2 peculiar features in our case: a smoldering course caused by an indolent organism and a significant time lag between initial FNA and clinical presentation. On literature review, it was found that the onset of acute bacterial suppurative thyroiditis after FNA can range from a few days to up to 3 months. Clinicians should be aware of this complication even if FNA has been performed a few months ago. Thyroid US and US-guided FNA are useful initial investigations. Conventional management of acute bacterial suppurative thyroiditis has been surgery combined with antimicrobial therapy. However, recently, a more conservative approach has been reported to be effective in the treatment of acute bacterial suppurative thyroiditis as well. Conclusion. Proper infection control practices are necessary in performing the FNA. Initial management (conservative versus surgical) of acute bacterial thyroiditis should be based on the patient’s clinical status and the extent of infective focus.

Chronic Suppurative Thyroid Abscess: A Case Report

“…It most commonly occurs as a sequela of acute suppurative thyroiditis (AST) which is frequently seen in children with anatomical abnormalities such as a pyriform sinus fistula [2] and thyroglossal duct cyst [3] (tend to present earlier in life) and in adults with pre-existing conditions such as Hashimoto's thyroiditis and thyroid malignancy [1]. Immunocompromised patients and those with a history of trauma such as FNAC and foreign body trauma from esophageal perforation are also at an increased risk of developing AST and thyroid abscess [4][5][6]. Infection may occur via lymphatic or hematogenous spread from distant sites, and organisms isolated include Staphylococcus, Streptococcus (accounting for 70 % of cases) [4], Klebsiella, Salmonella, Mycobacterium, and fungal infections in immunocompromised patients [7].…”

“…This patient did not have any congenital anomaly or immunodeficiency conditions. A case report and review of literature published in 2020 by Htet et al shows that around 10 cases of AST have been reported as a complication of FNA [ 5 ]. The existing research indicates that the development of acute bacterial suppurative thyroiditis from FNA can occur within a span of several days to three months.…”

“…The existing research indicates that the development of acute bacterial suppurative thyroiditis from FNA can occur within a span of several days to three months. Cases involving immunocompromised patients or infections caused by less virulent organisms often exhibit a prolonged, less noticeable onset or mild symptoms [ 5 ]. The index case presented to the clinic one year after her FNAC procedure with the sole complaint of discharge from the swelling, thus implying that she did not undergo a period of AST, and the abscess is a result of chronic suppuration.…”

Thyroid Abscess After Fine Needle Aspiration with Spontaneous Rupture into the Trachea : A Case Report

“…US is the imaging modality of choice in patients without a compromised airway due to its ability to discriminate the internal anatomy of the gland, and it provides an opportunity for immediate diagnostic and therapeutic aspiration. Thyroid US scans feature in AST include heterogeneous echo-texture of the thyroid gland and development of hypo-to-hyperechoic debris in the thyroid cystic fluid [15]. It is prudent to examine the aspirates and exclude thyroid malignancy that may masquerade as AST.…”

A Rare Complication of Fine-Needle Aspiration of Neck Structures

“…In addition to the uncommon risks of superficial biopsy discussed above, FNA of neck structures includes the rare risk of hematoma of the neck [ 7 ], seeding of cancer along the needle track [ 8 ], and acute bacterial suppurative thyroiditis [ 9 ]. Other risks have been theoretically speculated but have not, to our knowledge, been reported in the literature, including cyst fluid leakage, anaphylactic reaction, pneumothorax, and thromboembolism [ 10 ].…”