Introduction: Viral infections have been implicated as a possible predisposing factor in the pathogenesis of subacute thyroiditis (ST). The seasonal distribution and the common clinical presentation of ST following upper respiratory track infections suggest a possible causative association. Direct serological or thyroid tissue evidence of viral infection during ST is however limited to a few case reports.
Case presentation: We present the case of a 59-year-old woman with ST 2 weeks following acute viral meningitis due to Epstein-Barr virus infection. Two weeks prior to admission, the patient developed malaise, myalgia, sore throat and mild fever. One week prior to admission she deteriorated and complained of headache, neck pain and fever up to 38.5oC. On examination there was neck stiffness and marked tenderness on palpation of the thyroid gland. Cerebrospinal fluid analysis was consistent with lymphocytic meningitis. Biochemical tests revealed elevated liver enzymes, hyperthyroxinemia (FT4 4.86 ng/dl, 0.61.37) with suppressed TSH and negative thyroid autoantibodies. Thyroid scintigraphy with 99mTc showed reduced uptake, consistent with thyroiditis. Serological tests were indicative of acute Epstein-Barr virus infection (positive VCA IgM and IgG antibodies). CSF culture was negative for common bacteria and PCR testing failed to detect CMV,HSV-1,HSV-2,VZV,HHV-6, enterovirus or parechovirus DNA. A month later, the patient developed hypothyroidism and was started on thyroxine replacement.
Conclusion: Only two cases of EBV associated thyroiditis have been reported so far, based on a positive titer of anti-EBV Abs or the detection of EBV DNA by PCR. We present the case of a 59-year-old woman with concomitant viral meningitis and ST and serological tests indicating acute Epstein-Barr virus infection.
19 May 2018 - 22 May 2018