J. Endocrinol. Invest. 18.308-310.1995 CASE REPORT Thyroiditis due to Brucella Melitensis F. Vermiglio, G. Stassi, MD. Finocchiaro, and F. Trimarchi Cattedra di Endocrinologia e Istituto di Microbiologia, University of Messina, Messina,ltaly ABSTRACT. A case of thyroiditis due to Brucella Melitensis is reported. Brucellosis anticipated by about two months the onset of the characteristic symptoms of acute thyroiditis. Cultures of speci- mens obtained by fine needle aspiration biopsy and microbiological investigations allowed isolation and identification of the germ. This observation allowed INTRODUCTION Bacterial infections of thyroid gland are rare. Several different bacteria are involved in infective thyroiditis, even if staphylococci and streptococci have been isolated in most cases. (1) Brucella melitensis is a species of a genus of Gram- negative aerobic spherical or rodlike parasitic bac- teria responsible for a chronic disease of farm an- imals which can be transmitted to man either by contact with an infected animal or by drinking non- pasteurized contaminated milk or eating goat cheese. Such bacteria has been claimed as etio- logical factor only in a few cases of thyroiditis. CASE REPORT A 42-year-old woman was admitted to our Endocrinology Unit for the sudden appearance of a painful swelling of the anterior neck associated with sore-throat, dysphagia, dysphonia, neck discom- fort and persistent fever. Rectal temperature at ad- mission was 37.8 C. The recent history revealed during two months malaise, myalgias, anorexia, loss of weight, headache, nocturnal sweets. Wright test had showed a serum anti-brucella ag- glutin titer of 1:180. A 2 month's treatment with ciprofloxacin (1 g x day) Key-words. Brucellosis. thyroiditis. fine needle aspiration biopsy. Correspondence: Dr. M.D. Finocchiaro. Cattedra di Endocrinologia. Policlinico Universitario. Via Consolare Valeria I. 98123 Messina. Italy. Rece iv ed April 13. 1994; accepted November 11. 1994 308 the recognition that thyroid gland might harbored secondary localization of a prolonged brucellosis. A microbiological study (the protocol of which is pro- posed) of specimen obtained by fine needle aspi- ration biopsy should be performed in the presence of symptoms and signs of an inflammatory process associated to an acute swelling of the thyroid gland. by her phisycian was un effective resulting in the persistence of fever. She never had had iodine containing drugs or ra- diocontrast dyes for the past several years. On physical examination, she was 152 cm tall and her body weight was 57 Kg. Her blood pressure was 90/ 70 mmHg and pulse was 74/ min and was regular. She had diffusely enlarged left thyroid lobe. Basically, a rubbery hard and severely tender 4 cm nodule was palpable in the lower part of left thyroid lobe. Liver and spleen were palpable 2 cm below the re- spective costal margin , but remaining exa mination was normal. Red blood cells were 4.380.000/mm3; Hemoglobin was 10.6 g/dl; platelets 323.000 mm3. Total white blood cells were 4.400/mm3; a differential count demonstrated relative increase in lymphocyte num- ber (40%); serum iron concentration was 27 /lg /dl. Erytrocyte sedimentation rate was 52 mm/h, IgG, IgA and IgM serum concentrations were normal along with protein electrophoresis. Serum anti-bru- cella agglutinins were 1:800. Biochemical th yro id function study revealed normal serum concentra- tions of both total and free thyroid hormones being T3 1.8 nmol/L, T4 133 nmol/L, FT3 4.9 pmol/L, FT 4 22.9 pmol/L with normal se rum TSH concentration 0.55 /lU/ml ). Anti-thyroglobulin and anti-peroxidase antibody titers were in the normal range. A th yroid 99mTc scintiscan showed a widely reduced ra- dioisotope uptake of the right thyroid lobe and two areas of relatively higher isotope concentration cor- responding, respectively, to the upper and lower part of left thyroid lobe (Fig. 1A). Ultrasonography revealed a diffusely enlarged left