Fatal neck necrotizing cellulitis in a patient with Riedel's thyroiditis.

Fatal neck necrotizing cellulitis in a patient with Riedel's thyroiditis.

Mar 2013

Dupret-Bories A, Caron PJ, Rouquette I, Vairel B, Vergez S.

Source

CHU Hautepierre, Otolaryngology Head and Neck Surgery, Strasbourg, France ; agnes.dupret@chru-strasbourg.fr.

Abstract

Background: Riedel's thyroiditis (RT) is a rare chronic disease of the thyroid gland. In clinical practice, the first-line treatment is corticosteroids in symptomatic patients and in most cases the prognosis is favourable. Here we report a case of Riedel's thyroiditis with the development of necrotizing cellulitis of the neck after a wedge biopsy and during glucocorticoid treatment 

Patient Findings: An 81-year-old immunocompetent man presented with dysphonia and episodic dyspnea. An enlarged, hard and fixed thyroid mass was palpated and fibroscopic examination revealed a bilateral vocal cord immobility. A wedge biopsy was taken and a tracheotomy was performed. The histopathology was consistent with the diagnosis of Riedel's thyroiditis. The patient underwent a glucocorticoid treatment. After one month, an excavation of the surface of the neck appeared. 

Despite intravenous adapted antibiotic treatment and surgical debridement of the tissue necrosis, we observed a dramatic extension of cervical necrosis to the thorax. The patient died of severe sepsis 15 days after the surgery. 

Summary: In this patient, the diagnosis of Riedel's thyroiditis was made based on the clinical and histological criteria previously reported in the literature. In most cases, Riedel's thyroiditis has a benign course and mortality is extremely rare. Glucocorticoid therapy is usually effective and can lead to long-term remission. Here the patient developed a fatal neck necrotizing cellulitis 1 month after thyroid biopsy and glucocorticoid treatment. 

Conclusion: Massive necrotizing infection of the neck is rare and usually occurs as a complication of traumatic wounds in diabetic patients. We are unaware of similar cases in the literature of fatal neck necrotizing cellulitis in a patient with Riedel's thyroiditis.

Mary Ann Liebert