October - December 2005, Volume 1, Issue 4

Fica SV, Barbu C, Sirbu A, Terzea D, Clatici V, Ioachim D, Ionescu M

Rare form of tuberculosis presented as thyroid mass

Acta Endo (Buc) 2005, 1 (4): 481-487
doi: 10.4183/aeb.2005.481

Tuberculosis continues to be a universal health problem and recent studies showed an increased incidence of all forms of this disease. We report the case of a 81 year old female patient with a large left cervical tumour and cutaneous lesions that proved to be an unusual form of tuberculosis. The patient had a 2 years history of slowly increasing left cervical mass with no significant clinical manifestation. Medical assistance was requested mostly by the family, concerned about the large mass visible on the left side of the patient?s neck. Clinical and laboratory investigation revealed: a large left laterocervical tumour and the presence of erythematous, non pruriginous skin lesions. No significant changes were shown by routine blood tests. Thyroid function was in the normal range. Neck ultrasound revealed the presence of a 5/6 cm, well defined hypoechoic mass and the thyroid scan showed no accumulation of the radiotracer in the cervical tumour. Routine tuberculosis test was negative and the patient had no sign of pulmonary involvement. Histopathological examination after ablation of this tumour showed the presence of granulomatous lesions suggesting tuberculosis or sarcoidosis. The same aspect was seen after histopathological examination of the specimens from cutaneous biopsy. The diagnosis was certified by the PCR amplification of the DNA extracted from the skin lesions, which led to the identification of Mycobacterium tuberculosis. The cutaneous lesions were clearly improved after tuberculostatic treatment, supporting the hypothesis of a rare form of cutaneous tuberculosis.

Keywords: tuberculosis, thyroid mass, lupus vulgaris

Correspondence: Simona Fica, M.D. Department of Endocrinology, ?Carol Davila? University of Medicine and Pharmacy, Elias Hospital, 17, Marasti Av, Bucharest, Romania, tel: 0040213161614, e-mail:simonafica@yahoo.com.