Salmonella thyroid abscess in a pre-existing multinodular goitre: rare clinical entity with review of literature

Abstract

With its inherent resistance to infection, abscess of the thyroid has been rarely encountered clinically. The disease is usually preceded by an attack of upper respiratory tract infection. The availability of potent broad spectrum antibiotics is one important factor due to which currently thyroid abscess has become a rare clinical entity. But we report a case of thyroid abscess in an otherwise 26 yr old healthy young female with a long standing goitre. She gave no history of preceding URTI. The causative organism was identified as Salmonella typhi.

A pain in the neck: Salmonella spp. as an unusual cause of a thyroid abscess. A case report and review of the literature

“…The thyroid gland is rarely infected due its protective fibrous capsule, rich vascularity, lymphatic drainage, and high concentration of iodine and hydrogen peroxide inhibiting bacterial growth [1,5,11,12]. The incidence of AST and abscess formation is 0.1-0.7% of all reported thyroid lesions [6].…”

“…The incidence of AST and abscess formation is 0.1-0.7% of all reported thyroid lesions [6]. Abnormal thyroid anatomy, such as nodular goiter, cysts, and pyriform sinus fistulas can predispose to AST [5,13,14]. The latter originates from a third or fourth branchial cleft cyst anomaly, and can have tracts that connect the pyriform sinus and thyroid gland.…”

“…AST. Previous reports are summarized in Table 1 [1,2,5,[7][8][9][10]. Salmonella is a motile Gram-negative anaerobic bacillus with two main species; S. enterica and S. bongori [35].…”

“…However, a major predisposing factor to develop AST is immunocompromised status. Despite this, the incidence of thyroid infections in this population is less than 1% [3][4][5]14]. Uncontrolled DM, prolonged use of steroids, Human Immunodeficiency Virus (HIV), cancer, and post-transplantation immune suppression are most commonly implicated in patients with AST secondary to Salmonella spp.…”

“…Another predisposing factor for this condition is an immunocompromised state [3]. It is caused by bacterial pathogens, of which Gram-positive aerobes such as Staphylococcus aureus and Streptococcus pyogenes are the most common isolates [4][5][6]. Infections with Gramnegative facultative aerobes such as Salmonella spp.…”