Introduction: Acute thyroiditis is an uncommon illness that exceptionally presents with thyrotoxicosis. Differential diagnosis mainly includes subacute thyroiditis. Nocardia asteroides is an opportunistic pathogen, with the majority of infections occurring in immunocompromised patients, as the delay in diagnosis due to negative blood cultures makes it potentially letal.
Case report: We present a case of acute thyroiditis due to Nocardia that presents with thyrotoxicosis in a patient with diabetic nephropathy that received a kidney cadaveric transplantation. A 44-year-old woman with diabetic nephropathy had a cadaveric renal transplant. About 3 months later, she presented neck pain accompanied by fever, dysphagia, enlargement of thyroid gland and thyrotoxicosis. These findings together with image tests were consistent with subacute thyroiditis. However, worsening of symptoms despite usual treatment and the finding of an abscess in the ultrasonography study made us formulate the possibility of an acute thyroiditis. Fine-needle aspiration of the abscess and drainage were performed and Nocardia asteroides was isolated in the fluid culture. Owing to abscess persistence despite of drainage and specific antibiotic therapy surgical thyroidectomy was made.
Conclusions: Acute thyroiditis due to Nocardia is exceptional, with only six published cases in the literature, none of them presenting with thyrotoxicosis. It is the second known case of Nocardia thyroiditis in a patient with solid transplant organ, being the rest in patients under corticosteroids treatment. Nocardiosis is typically regarded as an opportunistic infection occurring in immunocompromised hosts and is it to be taken into account in these patients.
16 - 20 May 2015
European Society of Endocrinology