Acute Supurative Thyroiditis in Post Cimino Infection Patient

Abstract

Acute suppurative thyroiditis (AST) is a rare clinical case that must be treated immediately because of
its fatality, especially cases of swelling on thyroid area accompanied by fever. AST is often preceded
by infection, therefore it is necessary to find the source.A 40 years old woman came to the hospital with
complain of pain on the swollen neck,difficultyonswallowandfever. The patient suffered from chronic
kidney disease (CKD). One week before she had an AV hemodialysis shunt infection. Laboratory
results showed an increase of fT4 3.5 ug/dL and a decrease in TSH (0.015 uIU/mL), leukocytosis
and an increase of CRP. Thyroid ultrasound showed an abscess in entire left thyroid while thyroid
lobe FNAB showed AST. Pus culture showed the growth of Staphylococcus aureus bacteria. Thyroid
test supported an AST with hyperthyroidism and should be treated immediately. Three weeks after
treatment the patient was euthyroid and had drainage of the pus. AST occurred due to hemodialysis
AV shunt infection. Laboratory results show the presence of leukocytosis and increased of CRP levels,
supporting signs of inflammation. Pus culture revealed significant growth of Staphylococcus aureus
and improved with Clyndamycin therapy. To our knowledge, this is the first AST case preceded by
hemodialysis AV shunt infection.Cases of swelling on thyroid, painful swallowing, fever, preceded by
a shunt AV hemodialysis infection were considered to examine thyroid markers, ultrasound and FNAB
for early diagnosis of AST because it can be life-threatening.