# Suppurative Thyroiditis: Coinfection by Nocardia spp. and Mycobacterium tuberculosis in an Immunocompromised Patient

## TL;DR

This paper reports a rare case of suppurative thyroiditis caused by two bacteria in an immunocompromised patient, highlighting the importance of early diagnosis.

## Contribution

The first documented case of co-infection by Nocardia spp. and Mycobacterium tuberculosis in suppurative thyroiditis.

## Key findings

- Suppurative thyroiditis is rare and often occurs in immunocompromised individuals.
- Co-infection by Nocardia spp. and Mycobacterium tuberculosis was confirmed via fine-needle aspiration biopsy.
- Early clinical suspicion and timely diagnosis are critical to reduce morbidity and mortality.

## Abstract

Suppurative thyroiditis is a rare entity with a low incidence in thyroid diseases, manifesting with pain, fever, dysphagia, and dysphonia. Its infrequency is explained by the thyroid gland's resistance to infections due to its encapsulated position, high blood flow, bactericidal action of iodine, and extensive lymphatic network.

We present the first report in the literature of a 72-year-old woman with a history of inflammatory myopathy and immunosuppression diagnosed with suppurative thyroiditis co-infected with Nocardia spp. and Mycobacterium tuberculosis. This entity requires a high clinical suspicion, and fine-needle aspiration biopsy (FNAB) is preferred as the diagnostic method for microbiological sampling. Although rare, it carries high morbidity and mortality if not suspected in time.