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Acute suppurative thyroiditis as the initial presentation of juvenile systemic lupus erythematosus.
Robazzi, Teresa C M V; Alves, Cresio; Mendonça, Milena.
Afiliação
  • Robazzi TC; Pediatric Rheumatology Service, Hospital Universitário Professor Edgard Santos, Faculty of Medicine, Federal University ofBahia, Salvador, Bahia, Brazil. trobazzi@gmail.com
J Pediatr Endocrinol Metab ; 22(4): 379-83, 2009 Apr.
Article em En | MEDLINE | ID: mdl-19554814
We report an unusual case of acute suppurative thyroiditis associated with juvenile systemic lupus erythematosus (JSLE) onset. A 10 year-old girl presented with a painful voluminous swelling in the anterior cervical region with fever and dysphagia. She also had dysphonia, myalgia, swelling of the small joints of the hands, weight loss, and erythematous malar rash. Thyroid ultrasonography disclosed an ill-defined solid cystic area containing abundant echoes in suspension suggestive of an abscess in both lobes compatible with suppurative bacterial thyroiditis. Fine-needle aspiration biopsy showed a secretion with positive culture for Staphylococcus aureus. Endoscopic evaluation did not demonstrate pyriform sinus fistula. The child had no previous thyroid disease. Hormonal evaluation showed thyrotrophin (TSH) 13 microIU/ml and free thyroxine (FT4) 0.4 ng/dl. After laboratory confirmation of JSLE, high dose 'pulse' therapy was performed with methylprednisolone (30 mg/kg/day for 3 days), followed by prednisone (2 mg/kg/day). The acute thyroiditis was treated with oxacillin, metronidazole and amikacin which ameliorated the symptoms of infection followed by normalization of thyroid function with levothyroxine. In spite of the known association between autoimmune diseases and thyroid disorders, the coexistence of suppurative thyroiditis and JSLE is rare, generally occurring during the course of lupus and not at diagnosis.
Assuntos
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Tireoidite Supurativa / Lúpus Eritematoso Sistêmico Tipo de estudo: Diagnostic_studies Limite: Child / Female / Humans Idioma: En Revista: J Pediatr Endocrinol Metab Assunto da revista: ENDOCRINOLOGIA / PEDIATRIA Ano de publicação: 2009 Tipo de documento: Article País de afiliação: Brasil País de publicação: Alemanha
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Tireoidite Supurativa / Lúpus Eritematoso Sistêmico Tipo de estudo: Diagnostic_studies Limite: Child / Female / Humans Idioma: En Revista: J Pediatr Endocrinol Metab Assunto da revista: ENDOCRINOLOGIA / PEDIATRIA Ano de publicação: 2009 Tipo de documento: Article País de afiliação: Brasil País de publicação: Alemanha