Department of Pathology, School of Medicine, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia.
Department of Radiology, School of Medicine, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia.
J Med Case Rep. 2024 Jul 9;18(1):324. doi: 10.1186/s13256-024-04592-2.
Mycobacterium tuberculosis is the second most common infectious cause of death in adults worldwide. The ability of this organism to efficiently establish latent infection has enabled it to spread to nearly one-third of individuals worldwide. Approximately 8 million new cases of active tuberculosis disease occur each year, leading to about 1.7 million deaths. The disease incidence is magnified by the concurrent epidemic of human immunodeficiency virus infection. A total of 1.3 million people died from tuberculosis in 2022. In 2022, an estimated 10.6 million people fell ill with tuberculosis worldwide, including 5.8 million men, 3.5 million women, and 1.3 million children. We report a case of thyroid tuberculosis presenting as multinodular goiter. Neck ultrasound was done and revealed abscess collection on the background of multinodular colloid goiter. The diagnosis of thyroid tuberculosis was confirmed by a positive GeneXpert of the pus sample and the presence of extensive caseous necrosis on cytopathology examination. Furthermore, anterior neck swelling may provide a diagnostic challenge by clinically mimicking multinodular goiter or thyroid neoplasms. Owing to its rarity and its tendency to pose a clinical diagnostic challenge, we decided to report it.
A 60-year-old retired female Ethiopian high-school teacher presented to University of Gondar Hospital, Gondar, Ethiopia with firm, nontender multinodular anterior neck swelling measuring at largest 2 × 3 cm that moves with swallowing. GeneXpert of the pus sample and cytopathology examination confirmed the diagnosis of thyroid tuberculosis, and the patient was started on 2 rifampicin-ethambutol-isoniazid-pyrazinamide/4 rifampicin-isoniazid 3 tablets by mouth/day, which is defined as the preferred first-line anti-tuberculosis regimen in Ethiopia, and pyridoxine 50 mg by mouth per day for 6 months. Since then, she has been followed with regular liver function tests. The patient has shown a smooth course with no significant adverse effects encountered. Currently, the patient has completed her anti-tuberculosis treatment and is doing well.
In the clinical evaluation of a patient with anterior neck swelling, tuberculosis must be considered as a differential diagnosis in subjects from endemic areas for early diagnostic workup and management.
结核分枝杆菌是全球导致成年人死亡的第二大常见传染性病因。该病原体能够有效地建立潜伏感染，这使其在全球范围内传播到近三分之一的人群中。每年约有 800 万例新发活动性结核病病例，导致约 170 万人死亡。人类免疫缺陷病毒感染的同时流行放大了这种疾病的发病率。2022 年，共有 130 万人死于结核病。2022 年，全球估计有 1060 万人患有结核病，其中 580 万为男性，350 万为女性，130 万为儿童。我们报告了一例表现为多结节性甲状腺肿的甲状腺结核病例。颈部超声检查显示，在多结节胶体甲状腺肿的背景下存在脓肿积聚。脓液样本的 GeneXpert 阳性和细胞病理学检查中广泛出现干酪样坏死证实了甲状腺结核的诊断。此外，颈前肿胀可能通过在临床上模拟多结节性甲状腺肿或甲状腺肿瘤而提供诊断挑战。由于其罕见性及其倾向于构成临床诊断挑战，我们决定报告该病例。
一名 60 岁的退休埃塞俄比亚女高中教师因触及性、非触痛的颈前多结节性肿胀就诊，最大直径为 2×3cm，可随吞咽移动。脓液样本的 GeneXpert 和细胞病理学检查证实了甲状腺结核的诊断，患者开始接受 2 种利福平-乙胺丁醇-异烟肼-吡嗪酰胺/4 种利福平-异烟肼 3 片口服/天，这是埃塞俄比亚首选的一线抗结核方案，并每天口服 50mg 吡哆醇，持续 6 个月。此后，她定期进行肝功能检查。患者的治疗过程顺利，没有出现明显的不良反应。目前，患者已完成抗结核治疗，情况良好。
在颈前肿胀患者的临床评估中，对于来自流行地区的患者，必须考虑结核病作为鉴别诊断，以便进行早期诊断性检查和管理。
