Endocrinol Metab.  2012 Sep;27(3):222-226. 10.3803/EnM.2012.27.3.222.

A Case of Actinomycotic Thyroiditis in an Adult with Piriform Sinus Fistula

• Choi HJ
• Kim BW
• Shin MJ
• Choi BK
• Kang JH
• Jeon YK
• Kim SS
• Kim BH
• Kim IJ
• Kim YK

• KMID: 2282406
• DOI: http://doi.org/10.3803/EnM.2012.27.3.222

Abstract

Acute suppurative thyroiditis is an uncommon infectious thyroid disease affecting mainly children and young adults. The route of infection is frequently a pyriform sinus fistula. The major pathogens responsible for acute bacterial suppurative thyroiditis are the Streptococcus and Staphylococcus species. In contrast, Actinomyces species are a very rare cause of acute suppurative thyroiditis. We experienced a case of a 23-year-old man who has presented general weakness and neck pain. Thyroid ultrasonography showed an ill-defined area of heterogeneous hypoechogenicity in the left lobe of the thyroid gland. Histologic examination by fine needle aspiration demonstrated gram-positive, filamentous-like organisms with branching hyphae and characteristic sulfur granules. Barium esophagogram showed a linear barium-filled track at the left pyriform sinus. We report a case of actinomycotic thyroiditis in a young adult with pyriform sinus fistula along with a brief review of related literature.

Keyword

Actinomycosis; Pyriform sinus fistula; Thyroiditis

MeSH Terms

Actinomyces
Actinomycosis
Adult
Barium
Biopsy, Fine-Needle
Child
Fistula
Humans
Hyphae
Neck Pain
Pyriform Sinus
Staphylococcus
Streptococcus
Sulfur
Thyroid Diseases
Thyroid Gland
Thyroiditis
Thyroiditis, Suppurative
Track and Field
Young Adult
Barium
Sulfur

Figure

• 

  Fig. 1 Contrast-enhanced computed tomography scan of the neck demonstrated a 2 cm sized rim enhancing lesion with thick wall and necrotic portion at left lobe of thyroid gland (arrow) and 10 mm sized nodule at right lobe of thyroid gland (arrowhead).

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  Fig. 2 99mTc04 thyroid scan showed inhomogenous uptake, but there was no definite cold nodule.

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  Fig. 3 (A) Initial thyroid ultrasonography shows about 2 × 2 cm sized ill-defined heterogenous low echoic mass in left thyroid gland. (B) Thyroid ultrasonography after administration of antibiotics for 4 weeks shows decreased mass size (0.6 × 0.8 cm).

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  Fig. 4 Fine needle aspiration shows yellowish pink color pus like material.

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  Fig. 5 Histopathology demonstrated gram-positive, branching, thin, filamentous-like organisms suggestive of actinomyces, and the characteristic sulfur granules (H&E stain, × 400).

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  Fig. 6 Barium esophagogram shows linear barium filled track at left pyriform sinus fistula (arrow).

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