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

Approach to the patient with presumed cellulitis.

Approach to the patient with presumed cellulitis.

Semin Cutan Med Surg. 2007

Kroshinsky D, Grossman ME, Fox LP.
Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY.

Dermatologists frequently are consulted in the evaluation and management of the patient with cellulitic-appearing skin. For routine cellulitis, the clinical presentation and patient symptoms are usually sufficient for an accurate diagnosis. However, when the clinical presentation is somewhat atypical, or if the patient fails to respond to appropriate therapy for cellulitis because of routine bacterial pathogens, the differential diagnosis should be rapidly expanded. We discuss the approach to the patient with presumed cellulitis, with an emphasis on the differential diagnosis of cellulitis in both the immunocompetent and immunucompromised patient.

PMID: 18070684 [PubMed - in process]