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Abstract：
BACKGROUND: Mycobacterium tuberculosis is the second most common infectious cause of death in adults worldwide. The ability of this organism to efficiently establish latent infection has enabled it to spread to nearly one-third of individuals worldwide. Approximately 8 million new cases of active tuberculosis disease occur each year, leading to about 1.7 million deaths. The disease incidence is magnified by the concurrent epidemic of human immunodeficiency virus infection. A total of 1.3 million people died from tuberculosis in 2022. In 2022, an estimated 10.6 million people fell ill with tuberculosis worldwide, including 5.8 million men, 3.5 million women, and 1.3 million children. We report a case of thyroid tuberculosis presenting as multinodular goiter. Neck ultrasound was done and revealed abscess collection on the background of multinodular colloid goiter. The diagnosis of thyroid tuberculosis was confirmed by a positive GeneXpert of the pus sample and the presence of extensive caseous necrosis on cytopathology examination. Furthermore, anterior neck swelling may provide a diagnostic challenge by clinically mimicking multinodular goiter or thyroid neoplasms. Owing to its rarity and its tendency to pose a clinical diagnostic challenge, we decided to report it.
METHODS: A 60-year-old retired female Ethiopian high-school teacher presented to University of Gondar Hospital, Gondar, Ethiopia with firm, nontender multinodular anterior neck swelling measuring at largest 2 × 3 cm that moves with swallowing. GeneXpert of the pus sample and cytopathology examination confirmed the diagnosis of thyroid tuberculosis, and the patient was started on 2 rifampicin-ethambutol-isoniazid-pyrazinamide/4 rifampicin-isoniazid 3 tablets by mouth/day, which is defined as the preferred first-line anti-tuberculosis regimen in Ethiopia, and pyridoxine 50 mg by mouth per day for 6 months. Since then, she has been followed with regular liver function tests. The patient has shown a smooth course with no significant adverse effects encountered. Currently, the patient has completed her anti-tuberculosis treatment and is doing well.
CONCLUSIONS: In the clinical evaluation of a patient with anterior neck swelling, tuberculosis must be considered as a differential diagnosis in subjects from endemic areas for early diagnostic workup and management.
METHODS: A 60-year-old retired female Ethiopian high-school teacher presented to University of Gondar Hospital, Gondar, Ethiopia with firm, nontender multinodular anterior neck swelling measuring at largest 2 × 3 cm that moves with swallowing. GeneXpert of the pus sample and cytopathology examination confirmed the diagnosis of thyroid tuberculosis, and the patient was started on 2 rifampicin-ethambutol-isoniazid-pyrazinamide/4 rifampicin-isoniazid 3 tablets by mouth/day, which is defined as the preferred first-line anti-tuberculosis regimen in Ethiopia, and pyridoxine 50 mg by mouth per day for 6 months. Since then, she has been followed with regular liver function tests. The patient has shown a smooth course with no significant adverse effects encountered. Currently, the patient has completed her anti-tuberculosis treatment and is doing well.
CONCLUSIONS: In the clinical evaluation of a patient with anterior neck swelling, tuberculosis must be considered as a differential diagnosis in subjects from endemic areas for early diagnostic workup and management.
摘要：
背景：结核分枝杆菌是全球成年人死亡的第二大最常见的感染性原因。这种生物有效建立潜伏感染的能力使其能够传播到全世界近三分之一的个体。每年约有800万新的活动性结核病病例。导致约170万人死亡。人类免疫缺陷病毒感染的并发流行放大了该疾病的发病率。2022年，共有130万人死于结核病。2022年，全球估计有1060万人患有结核病。包括580万男性,350万女性,130万儿童。我们报告了一例甲状腺结核，表现为多结节性甲状腺肿。进行颈部超声检查，并在多结节性胶体甲状腺肿的背景下发现脓肿。通过脓液样本的GeneXpert阳性和在细胞病理学检查中存在广泛的干酪样坏死，证实了甲状腺结核的诊断。此外，颈前肿胀可能通过临床模拟多结节性甲状腺肿或甲状腺肿瘤来提供诊断挑战。由于其稀有性和对临床诊断构成挑战的倾向，我们决定报告。
方法：一位60岁的埃塞俄比亚高中退休女教师，Gondar,埃塞俄比亚坚定，最大为2×3厘米的无痛多结节性颈前肿胀，随吞咽移动。GeneXpert的脓液样本和细胞病理学检查证实诊断为甲状腺结核，患者开始口服2片利福平-乙胺丁醇-异烟肼-吡嗪酰胺/4片利福平-异烟肼3片/天，被定义为埃塞俄比亚首选的一线抗结核方案，和吡哆醇50毫克每天口服6个月。从那以后,她接受了定期肝功能检查。患者表现出平稳的过程，没有遇到明显的不良反应。目前,病人已完成抗结核治疗，情况良好。
结论：在颈前肿胀患者的临床评估中，结核病必须被视为来自流行地区的受试者的鉴别诊断，以便进行早期诊断和管理。
方法：一位60岁的埃塞俄比亚高中退休女教师，Gondar,埃塞俄比亚坚定，最大为2×3厘米的无痛多结节性颈前肿胀，随吞咽移动。GeneXpert的脓液样本和细胞病理学检查证实诊断为甲状腺结核，患者开始口服2片利福平-乙胺丁醇-异烟肼-吡嗪酰胺/4片利福平-异烟肼3片/天，被定义为埃塞俄比亚首选的一线抗结核方案，和吡哆醇50毫克每天口服6个月。从那以后,她接受了定期肝功能检查。患者表现出平稳的过程，没有遇到明显的不良反应。目前,病人已完成抗结核治疗，情况良好。
结论：在颈前肿胀患者的临床评估中，结核病必须被视为来自流行地区的受试者的鉴别诊断，以便进行早期诊断和管理。
