Clinical features of a case of brucellosis complicated with thyroid abscess
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目的 分析1例布鲁氏菌病（简称布病）并发甲状腺脓肿患者的临床特征与诊治过程，为布病并发甲状腺脓肿的临床诊断提供参考。 方法 收集2021年11月就诊于宁夏回族自治区吴忠市盐池县人民医院普外科的1例布病并发甲状腺脓肿患者的临床病历资料，对临床表现，血常规、布鲁氏菌抗体、甲状腺功能、细菌培养、甲状腺彩超等检查结果以及诊疗过程进行综合分析。 结果 患者为男性，61岁，因颈部肿物就诊，无典型布病临床表现，甲状腺彩超提示占位性病变，初步诊断为甲状腺囊腺瘤，拟行甲状腺右叶及峡部切除术。术中发现甲状腺部分腺体与颈内血管致密粘连，故切除术改为脓肿引流术，引出液为脓血性液体。甲状腺脓液（术中穿刺液和术后引流液）细菌培养结果为羊种布鲁氏菌阳性，且血清布鲁氏菌试管凝集试验滴度为1 ∶ 400（+++）。给予局部脓液引流及抗布鲁氏菌治疗后，患者好转出院，随访4个月，未见异常。 结论 以甲状腺局部感染起病的布病极为罕见，无特征性临床表现，易误诊。在治疗过程中及时纠正手术方案，避免患者甲状腺切除，具有一定临床借鉴作用。 Objective Clinical characteristics and diagnosis and treatment process was reported and analyzed of a patient with brucellosis complicated with thyroid abscess, providing reference for the clinical diagnosis of brucellosis complicated with thyroid abscess. Methods Clinical medical records of a patient with brucellosis complicated with thyroid abscess who was treated at the General Surgery Department of Yanchi County People's Hospital in Wuzhong City, Ningxia Hui Autonomous Region in November 2021 were collected. The clinical manifestations, blood routine,brucella antibodies, thyroid function, bacterial culture, thyroid ultrasound and other examination results, as well as the diagnosis and treatment process, were comprehensively analyzed. Results The patient was a male, 61 years old, who presented with a neck mass without typical clinical manifestations of brucellosis. Thyroid ultrasound revealed a space occupying lesion, and the preliminary diagnosis was thyroid cystadenoma. Thyroid right lobe and isthmus resection surgery was performed. During the operation, it was found that some of the thyroid glands were tightly adhered to the cervical blood vessels, so the resection surgery was changed to abscess drainage, and the drainage fluid was purulent and bloody. The bacterial culture result of thyroid purulent fluid (intraoperative puncture fluid and postoperative drainage fluid) was brucella lamblia, and the serum brucella test tube agglutination test titer was 1 ∶ 400 (+++). The patient improved and was discharged after local drainage and anti brucella treatment. Follow up for 4 months showed no abnormalities. Conclusions Brucellosis which begins with a local infection of the thyroid gland is extremely rare, with no characteristic clinical manifestations, and is prone to misdiagnosis. Timely correction of the surgical plan during the treatment process avoids the removal of the patient's thyroid, which has a certain clinical reference value.
Objective Clinical characteristics and diagnosis and treatment process was reported and analyzed of a patient with brucellosis complicated with thyroid abscess, providing reference for the clinical diagnosis of brucellosis complicated with thyroid abscess. Methods Clinical medical records of a patient with brucellosis complicated with thyroid abscess who was treated at the General Surgery Department of Yanchi County People's Hospital in Wuzhong City, Ningxia Hui Autonomous Region in November 2021 were collected. The clinical manifestations, blood routine,brucella antibodies, thyroid function, bacterial culture, thyroid ultrasound and other examination results, as well as the diagnosis and treatment process, were comprehensively analyzed. Results The patient was a male, 61 years old, who presented with a neck mass without typical clinical manifestations of brucellosis. Thyroid ultrasound revealed a space occupying lesion, and the preliminary diagnosis was thyroid cystadenoma. Thyroid right lobe and isthmus resection surgery was performed. During the operation, it was found that some of the thyroid glands were tightly adhered to the cervical blood vessels, so the resection surgery was changed to abscess drainage, and the drainage fluid was purulent and bloody. The bacterial culture result of thyroid purulent fluid (intraoperative puncture fluid and postoperative drainage fluid) was brucella lamblia, and the serum brucella test tube agglutination test titer was 1 ∶ 400 (+++). The patient improved and was discharged after local drainage and anti brucella treatment. Follow up for 4 months showed no abnormalities. Conclusions Brucellosis which begins with a local infection of the thyroid gland is extremely rare, with no characteristic clinical manifestations, and is prone to misdiagnosis. Timely correction of the surgical plan during the treatment process avoids the removal of the patient's thyroid, which has a certain clinical reference value.
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