THYROID ABSCESSES COMPLICATED WITH SEPSIS (CLINICAL CASE)

Abstract

Aim – to demonstrate the features of diagnosis and surgical treatment of thyroid gland abscesses complicated by sepsis.

Materials and methods. Patient B., 45 years old, was admitted to the Military Medical Clinical Center of the Northern Region (MMCC NR) with complaints of general weakness, aching pain in the lower extremities. From the anamnesis it is known that he has been ill for about 4 months. He was treated in one of the multidisciplinary hospitals of Kharkiv. A week before admission to the MMCC NR, arthronecrectomy, drainage of the right knee joint, and opening of abscesses in the lower jaw and lower third of the left thigh were performed.

The patient was examined, a general blood and urine test, a biochemical urine test, a blood coagulogram, a blood group and Rh factor, blood tests for hepatitis, HIV and syphilis, thyroid hormones, culture of punctate from abscesses for microflora and sensitivity to antibiotics, lumbar punctures, ultrasound examination of the thyroid gland, electrocardiography, multispiral computed tomography (MSCT) of the head, neck and chest organs with and without contrast were performed.

Results. In the blood culture for microflora and sensitivity to antibiotics, Actinomyces sp. was detected. According to the MSCT of the head, neck and chest organs, multiple hypodense foci of supratentorial and subtentorial structures of the brain, acute purulent thyroiditis, abscesses of the right and left thyroid lobes, mediastinal lymphadenopathy were detected.

In the culture study of the thyroid punctate and the right knee joint, Actinomyces sp. 105 was detected. In the blood culture for microflora, Actinomyces sp. was detected.

Final diagnosis: chronic generalized actinomycosis. Purulent gonitis of both knee joints. Abscesses of the lower jaw, left thigh, right forearm. Multiple hypodense foci of supratentorial and subtentorial structures of the brain. Secondary meningoencephalitis. Acute purulent thyroiditis. Abscesses of the right and left thyroid lobes. Late hospital-acquired pneumonia in the lower lobe of the right lung, mild course, III clinical group, DN 0. Acute surgical sepsis associated with Actinomyces sp., stage septicopyemia. Hypertensive disease stage 2, degree 3, high risk. Surgery (7 days before admission): arthronecrectomy. Drainage of the right knee joint. Opening of abscesses in the lower jaw and lower third of the left thigh. Surgery (upon admission): opening and drainage of abscess of the right forearm. Surgery (on the second day after admission): opening and drainage of abscesses of the right and left thyroid lobes. Placement of a flow-washing system in the right knee joint, removed on the 5th day. On the 19th day after admission, the operation was performed: secondary repeated surgical treatment of the neck wound, suturing of the neck wound, drainage of the postoperative wound.

Thyroid hormones on admission: free triiodothyronine – 3.4 pmol/L, free thyroxine – 41.1 pmol/L, thyroid-stimulating hormone – 0.07 μIU/mL, antibodies to thyroid peroxidase – 0.01 U/mL; after 2 weeks: free triiodothyronine – 2.3 pmol/L, free thyroxine – 14 pmol/L, thyroid-stimulating hormone – 0.3 μIU/mL, antibodies to thyroid peroxidase – 2.8 U/mL.

On the twenty-fourth day after admission, the patient was transferred to the next level of medical care, where after 4 days the drains were removed from the postoperative wound, the sutures were removed after 10 days. The wounds on the neck healed with secondary tension. The total bed-day was 34 days. The patient was presented to the military medical commission, according to its decision he received a leave of absence for health reasons for 30 calendar days.

Conclusions. Thyroid abscesses on the background of sepsis associated with Actinomyces sp. are a rare pathology. In the diagnosis of thyroid abscesses, the leading methods of investigation are MSCT of the neck, puncture of abscesses under ultrasound control, examination of punctate for microflora, complete blood count and examination of thyroid hormones. In the treatment of thyroid abscesses, the main directions are surgical treatment aimed at the sanitation of the focus of infection, antibacterial therapy is prescribed according to the sensitivity to the infectious agent.