Thyroid Abscess Due to Acinetobacter calcoaceticus: Case Report and Review of the Causes of and Current Management Strategies for Thyroid Abscesses

Avrum Jacobs, MD, David-Alexandre C. Gros, MD, Jeremy D. Gradon, MD

Disclosures

South Med J. 2003;96(3) 

In This Article

Abstract and Introduction

Thyroid abscess was a common condition in the era before antibiotics. In the current medical environment, however, it is a clinical entity that is seldom encountered. We report the case of a unique cause of thyroid abscess, the environmental Gram-negative bacterium Acinetobacter calcoaceticus. Review of the published causes of thyroid abscess since 1980 demonstrated that although Gram-positive bacteria (Staphylococcus and Streptococcus species) remain the most common causes, there has been a marked decrease in the number of cases caused by mycobacteria, Salmonella species, and anaerobes when compared with the early part of the 20th century. Patients infected with the human immunodeficiency virus, however, still develop mycobacterial and fungal thyroid infections with some regularity. Reported modes of management of thyroid abscess vary, but drainage remains an integral component of therapy for resolution of the infection.

Bacterial thyroid abscess is an uncommon condition. The microbiologic etiology of this process is usually a Gram-positive organism such as Staphylococcus or Streptococcus species. Gram-negative suppurative thyroiditis is rarely reported. We describe what we believe to be the first reported case of primary thyroid-gland infection caused by the Gram-negative rod, Acinetobacter. In addition, we provide an update on the literature regarding the cause and management of thyroid abscess, including the microbiology of thyroid infections occurring in people infected with the human immunodeficiency virus (HIV). Two large reviews of cases characterized by thyroid abscess or the presence of microorganisms in the thyroid gland have been published in the past 2 decades. Berger et al[1] reviewed 224 cases reported in the English-language literature from 1900 to 1980, and Yu et al[2] reviewed an additional 191 cases from 1980 to April 1997. In this report, we examine the remaining cases of suppurative thyroiditis from 1980 to 2000 not reviewed previously. We discovered 86 additional cases, including our own case report. We compare the pathogens infecting the thyroid ( Table 1 ) found by our literature search with those reported by Berger et al[1] and Yu et al[2] and also review the treatment course of each case ( Table 2 ).

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