IMAGES IN CYTOLOGY Section Editor: Shahla Massod, M.D.
Salmonella Thyroid Abscess in Human Immunodeficiency Virus-Positive Man: A Diagnostic Pitfall in Fine-Needle Aspiration Biopsy of Thyroid Lesions Sofia Kazi, M.D.,1* Hui Liu, M.D.,1 Nancy Jiang, M.D.,2 Joelle Glick, M.D.,2 Marita Teng, M.D.,2 Vincent LaBombardi, Ph.D.,1 Arnold H. Szporn, M.D.,1 and Hua Chen, M.D. Ph.D.1
Acute suppurative thyroiditis (AST) is extremely rare, representing 0.1%–0.7% of all thyroid disease.1 This low incidence may be explained by the gland’s rich vascularity, protective capsule, and high iodine content.2 Staphylococcus and Streptococcus species are the causative organisms in the majority of cases of AST. According to Paes, gram negative aerobes account for approximately 25% of AST, with about 30% of AST being polymicrobial. Salmonella thyroid abscess is exceedingly rare and only a few cases have been reported.2 Because this entity is quite virulent and can be rapidly fatal, especially in an HIV-positive patient, it represents a potentially important pitfall in fine needle aspiration (FNA) biopsy. We report the case of a 52-year-old human immunodeficiency virus (HIV) positive man who presented with fevers of unknown origin as high as 103 F, chills, and night sweats for 1 month after recent international travel to Turkey. He also reported an unintentional 30-lb weight loss and loss of appetite, though he denied diarrhea. On physical examina1 Department of Pathology, Icahn School of Medicine at Mount Sinai, New York 2 Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York *Correspondence to: S. Kazi, M.D., One Gustave L. Levy Place, Box 1194, New York, NY 10029, USA. E-mail: [email protected] Received 10 June 2013; Revised 22 September 2013; Accepted 9 January 2014 DOI: 10.1002/dc.23117 Published online 00 Month 2014 in Wiley Online Library (wileyonlinelibrary.com).
C 2014 WILEY PERIODICALS, INC. V
tion, the patient was emaciated and diaphoretic with a firm, non-tender thyroid mass. The patient’s cluster of differentiation (CD)-4 count 4 months prior to admission was 307 cells/mm3 with a detectable but low HIV viral load (
Salmonella Thyroid Abscess in Human Immunodeficiency Virus-Positive Man: A Diagnostic Pitfall in Fine-Needle Aspiration Biopsy of Thyroid Lesions Sofia Kazi, M.D.,1* Hui Liu, M.D.,1 Nancy Jiang, M.D.,2 Joelle Glick, M.D.,2 Marita Teng, M.D.,2 Vincent LaBombardi, Ph.D.,1 Arnold H. Szporn, M.D.,1 and Hua Chen, M.D. Ph.D.1
Acute suppurative thyroiditis (AST) is extremely rare, representing 0.1%–0.7% of all thyroid disease.1 This low incidence may be explained by the gland’s rich vascularity, protective capsule, and high iodine content.2 Staphylococcus and Streptococcus species are the causative organisms in the majority of cases of AST. According to Paes, gram negative aerobes account for approximately 25% of AST, with about 30% of AST being polymicrobial. Salmonella thyroid abscess is exceedingly rare and only a few cases have been reported.2 Because this entity is quite virulent and can be rapidly fatal, especially in an HIV-positive patient, it represents a potentially important pitfall in fine needle aspiration (FNA) biopsy. We report the case of a 52-year-old human immunodeficiency virus (HIV) positive man who presented with fevers of unknown origin as high as 103 F, chills, and night sweats for 1 month after recent international travel to Turkey. He also reported an unintentional 30-lb weight loss and loss of appetite, though he denied diarrhea. On physical examina1 Department of Pathology, Icahn School of Medicine at Mount Sinai, New York 2 Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York *Correspondence to: S. Kazi, M.D., One Gustave L. Levy Place, Box 1194, New York, NY 10029, USA. E-mail: [email protected] Received 10 June 2013; Revised 22 September 2013; Accepted 9 January 2014 DOI: 10.1002/dc.23117 Published online 00 Month 2014 in Wiley Online Library (wileyonlinelibrary.com).
C 2014 WILEY PERIODICALS, INC. V
tion, the patient was emaciated and diaphoretic with a firm, non-tender thyroid mass. The patient’s cluster of differentiation (CD)-4 count 4 months prior to admission was 307 cells/mm3 with a detectable but low HIV viral load (
