1例毗邻颗粒链球菌致急性化脓性甲状腺炎诊治的报道

田睿

[摘要]急性化脓性甲状腺炎在临床上较为罕见，其临床表现复杂多样，容易误诊、漏诊，如不及时诊断和治疗，延误病情，具有潜在致命性。本文对2019年8月5日入院的1例毗邻颗粒链球菌致急性化脓性甲状腺炎患者进行分析与总结，结合实际的发病及诊疗过程，对该病的临床表现、诊断、鉴别诊断及治疗措施进行探讨，提出临床医生应时刻警惕颈前疼痛患者，脓肿形成后应及早行脓肿穿刺引流或切开排脓及彻底清创。

[关键词]毗邻颗粒链球菌;急性化脓性甲状腺炎;颈前疼痛

[中图分类号] R581.4          [文献标识码] A          [文章编号] 1674-4721（2020）7（b）-0201-04

Diagnosis and treatment of acute suppurative thyroiditis caused by Granulicatella adiacens：a case report

TIAN Rui

Department of Endocrinology， Dongguan Donghua Hospital， Guangdong Province， Dongguan   523110， China

[Abstract] Acute suppurative thyroiditis is rarely seen in the clinic， and its clinical manifestations are complex and diverse， and it is easy to be misdiagnosed or missed. If it is not diagnosed and treated in time， the whole condition will be delayed and it will develop to be potentially fatal. This article analyzes and summarizes a patient with acute suppurative thyroiditis caused by Granulicatella adiacens admitted to our hospital on August 5， 2019. Combining the actual morbidity and diagnosis and treatment process， the clinical manifestations， diagnosis， differential diagnosis and treatment measures of the disease are discussed. It is suggested that clinicians should always be alert to patients with anterior cervical pain， after abscess formation， drainage of the abscess or incision to drain the pus and complete debridement should be performed as soon as possible.

[Key words] Granulicatella adiacens; Acute suppurative thyroiditis; Anterior cervical pain

急性化膿性甲状腺炎（acute suppurative thyroidiits，AST）是一种临床上罕见的甲状腺非特异性感染性疾病[1-2]。由于其临床表现复杂多变、早期诊断困难、脓肿可在短时间内迅速长大、病情进展迅速，如不及时诊断和治疗，常具有潜在致命性。AST常见致病菌为金黄色葡萄球菌，也可见于链球菌、肺炎球菌、布鲁菌、真菌、病毒、寄生虫感染等。毗邻颗粒链球菌[3]是人口咽部、泌尿生殖道和肠道的正常菌群，机体免疫力低下时可引起感染性心内膜炎、中耳炎和菌血症等，极少发生在甲状腺，此类病例文献鲜有报道。本文报道1例我院经治的毗邻颗粒链球菌致AST，经甲状腺细针穿刺活检（fine needle aspiration bidpsy，FNAB）和细菌学培养明确诊断。

1病例资料

患者，男，25岁，因“反复颈前疼痛伴发热3周”于2019年8月5日入院。患者于入院3周前受凉后出现颈前区疼痛，吞咽及按压时加重，左侧为主，无耳后、枕部放射性疼痛，伴咽痛、发热，体温最高39.3℃，伴有乏力、纳差，发热时伴头晕、头痛，无明显咳嗽、咳痰、胸闷、气促，未介意。……