Suppurative thyroiditis due to Nocardia asteroides

Lewin, Sharon R.; Street, Alan; Snider, Jared L.

doi:10.1016/0163-4453(93)95937-e

Cited by 11 publications

(12 citation statements)

References 5 publications

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“…Primary nocardiosis often manifests as a pulmonary disease with cough, dyspnea, and fever. However, approximately a third of nocardiosis cases disseminate to other tissues including brain, meninges, and subcutaneous tissues (5).…”

Section: Discussionmentioning

confidence: 99%

Suppurative Thyroiditis due to Nocardia in An Immunocompromised Patient

Ali

Sholl

et al. 2018

AACE Clinical Case Reports

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Objective: Nocardia is an opportunistic organism that usually infects immunocompromised patients. However, suppurative thyroiditis is a rare complication of nocardiosis. Methods: We report a case of Nocardia thyroiditis in an immunosuppressed patient following renal transplant. Results: A 45-year-old man presented with worsening diffuse muscle pain, weakness, and subjective fever. He had a significant history of recent renal transplant with immunosuppression at the time of presentation. Mild swelling was noted in the right submandibular area, and multiple papules were noted on the skin. Although pulmonary exam revealed no abnormalities, computed tomography revealed numerous bilateral small pulmonary nodules and multiple hypodense thyroid nodules. A positron emission tomography scan showed hypermetabolic activity in the mediastinum, lungs, thyroid, and skeletal muscles. During a rightthyroid lobectomy to rule out post-transplant lymphoproliferative disease, purulent discharge from a ruptured cyst was identified. Histopathology revealed granulomatous, focally suppurative thyroiditis and filamentous microorganisms morphologically resembling Nocardia. The pathological and clinical findings in the thyroid, lungs, skin, and nervous system correlated with disseminated nocardiosis. Conclusion: Nocardia thyroiditis is a rare presentation of disseminated nocardiosis. Diagnosis in our case was achieved upon analysis of unusual purulent drainage during thyroid lobectomy for suspicion of post-transplant lymphoma. Thyroidectomy may be considered in resistant and recurrent Nocardia thyroiditis following surgical drainage and antibiotic management. Although most cases of suppurative thyroiditis are of bacterial origin, this case suggests the importance of considering Nocardia as a possible etiological agent of suppurative thyroiditis, particularly in an immunocompromised patient with additional pulmonary, cutaneous, and nervous system manifestations.

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Section: Discussionmentioning

confidence: 99%

Suppurative Thyroiditis due to Nocardia in An Immunocompromised Patient

Ali

Sholl

et al. 2018

AACE Clinical Case Reports

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“…The thyroid location of Nocardia infection is unusual. However, a case report of a thyroid Nocardia infection in an immunocompromised patient with systemic lupus erythematosus was published in 1993 (11). We report here on a second case of Nocardia thyroiditis in the recipient of a combined liver-kidney transplant undergoing immunosuppressor treatment.…”

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confidence: 84%

“…The most common etiologic agents isolated are Streptococcus pyogenes, Staphylococcus aureus, and Streptococcus pneumoniae, although other bacteria including Escherichia coli, Haemophilus influenzae, meningococcal organisms, and anaerobes have been reported as causes of infection (2). To our knowledge, Nocardia has been described as a pathogen responsible for thyroid abscess in only one patient in 1993 (11). The patient was a 20-year-old woman who had a 2-year history of lupus nephritis and who had been treated with prednisone and cyclophosphamide.…”

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confidence: 99%

Nocardia Thyroiditis: Unusual Location of Infection

et al. 1999

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Nocardia asteroides complex is an important opportunistic agent in immunocompromised hosts. Usually, primary pulmonary infection occurs and is followed by dissemination of the pathogen to the central nervous system and soft tissues. As described in the literature, almost every organ can be infected, but to our knowledge, Nocardia has been described as a pathogen responsible for thyroid abscess in only one report, which was published in 1993. The present report is the second case report ofNocardia thyroiditis. The patient was under immunosuppressor treatment following a combined liver-kidney transplant and presented with a preexisting nodular goiter which was probably a predisposing factor to the start and development of the thyroid infection.

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“…Thyroiditis caused by Nocardia is extremely rare and only 8 cases have been described in the literature [5,7,8,9,10,11,12,13]. Of these, N. asteroides was cultured in 7 cases and N. farcinica in 1 case.…”

Section: Introductionmentioning

confidence: 99%

“…Most of the reports made no mention of abnormal thyroid function at the time of presentation. Subclinical hypothyroidism developed in only 1 patient after 12 weeks [8]. Outcomes were poor and half of the patients demised [7,10,11,12].…”

Section: Introductionmentioning

confidence: 99%

Thyrotoxicosis followed by Hypothyroidism due to Suppurative Thyroiditis Caused by <b><i>Nocardia brasiliensis</i></b> in a Patient with Advanced Acquired Immunodeficiency Syndrome

Teckie¹,

Bhana²,

Tsitsi³

et al. 2013

Eur Thyroid J

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Acute thyroiditis is an extremely rare complication of nocardiosis. We report a patient with hyperthyroidism due to suppurative thyroiditis caused by Nocardia brasiliensis. A 38-year-old Black male presented with features of thyrotoxicosis, sepsis and airway obstruction. He had no evidence of underlying thyroid disease, but was severely immunocompromised as a result of acquired immunodeficiency syndrome. He had previously been diagnosed with pulmonary nocardiosis and also had nocardial abscesses on his anterior chest wall. Investigations revealed thyrotoxicosis, with a FT₄ of 43.2 pmol/l and a suppressed TSH <0.01 mIU/l. Serum anti-thyroperoxidase and anti-thyroglobulin antibodies were absent. Computed tomography scan showed a large abscess in the anterior neck involving the left lobe and isthmus, as well as inhomogeneous changes in the right lobe of the thyroid. The radioisotopic scan showed absent uptake of tracer in keeping with thyroiditis. Although the initial presentation was that of hyperthyroidism, destruction of the gland later resulted in sustained hypothyroidism, necessitating thyroid hormone supplementation. The hyperthyroidism can be explained by the release of presynthesized and stored thyroid hormone into the circulation as a result of inflammation and disruption of the thyroid follicles, and the subsequent hypothyroidism by the fact that much of the gland was destroyed by the abscess and the extensive inflammatory process. This is the first documented case of hyperthyroidism in a patient with acute suppurative thyroiditis caused by Nocardia.

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Suppurative thyroiditis due to Nocardia asteroides

Cited by 11 publications

References 5 publications

Suppurative Thyroiditis due to Nocardia in An Immunocompromised Patient

Suppurative Thyroiditis due to Nocardia in An Immunocompromised Patient

Nocardia Thyroiditis: Unusual Location of Infection

Thyrotoxicosis followed by Hypothyroidism due to Suppurative Thyroiditis Caused by <b><i>Nocardia brasiliensis</i></b> in a Patient with Advanced Acquired Immunodeficiency Syndrome

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