A 21-year-old woman presented to the emergency department with one day of painful swallowing, neck pain, fever and headache. Initially diagnosed with tonsillitis and treated with oral amoxicillin, her condition worsened, resulting in tender cervical swelling and dysphagia. Examination revealed a large, indurated left-sided goiter. Laboratory tests showed leukocytosis and elevated C-reactive protein. A CT-scan identified a 4 × 4 cm intrathyroidal abscess (Fig. 1). Following fine-needle aspiration and broad-spectrum antibiotics, treatment was adjusted to targeted intravenous antibiotic therapy when cultures revealed S. anginosus. The esophagogram, fiberoptic rhinolaryngoscopy and esophagogastroduodenoscopy showed no anatomical abnormalities like pyriform sinus fistula, thyroglossal duct persistence, or branchial arch malformations.
Diagnosis: Acute suppurative thyroiditis.
