A previously healthy 17-year-old female patient initially presented with symptoms of anterior neck pain. After multiple emergency department visits, she was found to have unilateral enlargement of her thyroid gland. Laboratory studies were consistent with hyperthyroidism. Symptoms were initially attributed to subacute thyroiditis, and she was discharged with steroids and propranolol. She presented again 1 week later with complaints of nausea, vomiting, abdominal pain, and shortness of breath. She was readmitted and developed sepsis with multiorgan system infection and Lemierre syndrome. Further imaging revealed acute suppurative thyroiditis as the likely source. Direct laryngoscopy and bronchoscopy revealed ulceration of the anterior esophageal wall, a fistulous tract to the thyroid, and copious purulent drainage. Esophageal biopsies with immunostaining established a diagnosis of herpes simplex virus esophagitis as the likely cause of esophageal perforation, fistula development, and acute suppurative thyroiditis.

中文翻译：

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急性化脓性甲状腺炎的罕见表现。


一名既往健康的 17 岁女性患者最初出现颈前部疼痛症状。在多次急诊科就诊后，发现她的甲状腺单侧肿大。实验室检查与甲状腺功能亢进一致。症状最初归因于亚急性甲状腺炎，她出院时服用了类固醇和普萘洛尔。1 周后，她再次就诊，主诉恶心、呕吐、腹痛和呼吸短促。她再次入院并发展为脓毒症伴多器官系统感染和 Lemierre 综合征。进一步的影像学检查显示急性化脓性甲状腺炎是可能的来源。直接喉镜检查和支气管镜检查显示食管前壁溃疡、甲状腺瘘管和大量脓性引流。食管活检和免疫染色确定单纯疱疹病毒性食管炎的诊断是食管穿孔、瘘管发展和急性化脓性甲状腺炎的可能原因。