E. coli mediated Acute Suppurative Thyroiditis with Thyroid abscess in a patient with Urosepsis: Case report

Abstract

Introduction: Thyroid abscesses are rare modalities of infectious pathology of the thyroid gland. The thyroid is highly resistant to infection due to high iodine content, capsule, and rich vascularity. Acute suppurative thyroiditis represents less than 1% of thyroid diseases, but if present, could potentially lead to a life-threatening endocrine emergency. Case Presentation: A 62 year-old elderly diabetic lady presented with complaints of sudden onset anterior neck swelling and difficulty in swallowing for a week. She had a history of Urinary Tract Infection leading to Acute Kidney Injury and Urosepsis twenty days back, which was managed conservatively by antibiotics. Bacteraemia from the urosepsis spread to thyroid gland leading to Acute Suppurative Thyroiditis and thyroid abscess. Patient developed acute onset painful enlargement of thyroid gland. Incision and drainage of the neck abscess was done along with left thyroid lobectomy and tracheostomy. She developed left vocal cord paresis postoperatively, but the hoarseness improved after three months. Regular dressing and parenteral antibiotics against E. coli resulted in complete wound healing in two weeks. Conclusion: We found an association of urinary tract infection with thyroid abscess which was confirmed by E.coli positivity in thyroid abscess pus culture report and previous urine culture reports. In cases of acute suppurative thyroiditis with thyroid abscess, the primary source of infection should be searched and meticulously treated because in majority of cases it occurs due to bacteriological spread from a distant site in the body.