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Choi, Kim, Shin, Choi, Kang, Jeon, Kim, Kim, Kim, and Kim: A Case of Actinomycotic Thyroiditis in an Adult with Piriform Sinus Fistula
Case Report
Endocrinology and Metabolism

Endocrinology and Metabolism 2012; 27(3): 222-226.

Published online: 19 September 2012

DOI: https://doi.org/10.3803/EnM.2012.27.3.222

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

Hyun Ju Choi, Bo Won Kim, Min Ji Shin, Bo Kwang Choi, Ji Hyun Kang, Yun Kyung Jeon, Sang Soo Kim, Bo Hyun Kim, In Ju Kim, Yong Ki Kim1

Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

1Kim Yong Ki Internal Medicine Clinic, Busan, Korea.

Corresponding author: Bo Hyun Kim. Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, 305 Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel: +82-51-240-7678, Fax: +82-51-254-3217, pons71@hanmail.net

Received 14 August 2011       Accepted 25 October 2011

Copyright © 2012 Korean Endocrine Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Actinomycosis, Pyriform sinus fistula, Thyroiditis

Figures and Tables

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).
enm-27-222-g005
Fig. 6
Barium esophagogram shows linear barium filled track at left pyriform sinus fistula (arrow).
enm-27-222-g006

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