Presentation
Raised inflammatory markers in an immunosuppressed patient. Previous medical history of lung infections, hepatic abscess, peri-orbital abscess, and perianal abscess.
Patient Data
Ill-defined hypodense areas infiltrating and partially encasing the right thyroid is concerning for abscess in this setting. Further ultrasound recommended.
Ultrasound confirmed a permeative fluid collection within the right thyroid lobe highly suggestive for an abscess. Aspiration was performed with a 20G needle and pale purulent material was obtained and sent for MCS.
Case Discussion
Chronic granulomatous disease is a rare genetic immunodeficiency related to neutrophil function impairment. In a simple way to understand it, these cells are unable to kill certain microorganisms, which survive within the phagosome leading to chronic inflammatory cell reactions and therefore granuloma formation. These patients will have recurrent infections affecting different organs, persistent inflammation, and the establishment of granulomas.
This young patient was diagnosed in early childhood and has had multiple hospital admissions for recurrent infections. The largest fluid pocket in the right thyroid lobe was aspirated and cultured positive for Aspergillus.