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Case Report: Disseminated Burkholderia pseudomallei with Acute Suppurative Thyroiditis and Abscess Formation

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  • 1 Cairns Hospital, Cairns, Queensland, Australia;
  • | 2 James Cook University, Cairns, Queensland, Australia;
  • | 3 The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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ABSTRACT.

Melioidosis has a highly variable presentation. Almost any organ can be involved, although an antemortem diagnosis of acute suppurative thyroiditis (AST) has not, to our knowledge, been described previously. A 68-year-old Australian male with poorly controlled type 2 diabetes mellitus presented with fever, odynophagia, and thyroid function tests that were consistent with hyperthyroidism. Imaging demonstrated a lung abscess and an enlarged thyroid gland with three nodules. Blood cultures and fine-needle aspiration of the thyroid nodules grew Burkholderia pseudomallei. He received intravenous ceftazidime with concurrent oral trimethoprim/sulfamethoxazole (TMP/SMX) for 4 weeks followed by high-dose oral TMP/SMX for a further 3 months and made a complete recovery. Acute suppurative thyroiditis is an uncommon cause of hyperthyroidism and thyroid aspirates are not commonly sent for bacterial culture. The case highlights the need to consider AST in patients presenting with a hyperthyroid state and disseminated infection. It also demonstrates that in a case of disseminated melioidosis any symptom may be a clue to underlying metastatic infection.

Author Notes

Address correspondence to Josh Hanson, The Kirby Institute, University of New South Wales, Wallace Wurth Bldg., Sydney, New South Wales 2052, Australia. E-mail: jhanson@kirby.unsw.edu.au

Authors’ addresses: Julian Harris, Simon Smith, and Soong Zheng Ng, Cairns Hospital, Cairns, Queensland, Australia, E-mails: Julian.Harris@health.qld.gov.au, Simon.Smith2@health.qld.gov.au, and Soong.Ng@health.qld.gov.au. Ashim Sinha, Cairns Hospital, Cairns, Queensland, Australia, and James Cook University, Cairns, Queensland, Australia, E-mail: Ashim.Sinha@health.qld.gov.au. Josh Hanson, Cairns Hospital, Cairns, Queensland, Australia, and The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia, E-mail: jhanson@kirby.unsw.edu.au.

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