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

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 previously described. A 68-year-old Australian male with poorly controlled type 2 diabetes mellitus presented with fever, odynophagia, and thyroid function tests 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 and 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.