Acute suppurative thyroiditis in a child secondary to pyriform sinus fistula: From single case to systematic review

Acute suppurative thyroiditis (AST), a rare yet potentially life-threatening infection, comprises less than 1 % of neck pathologies and requires prompt treatment. Symptoms range from neck pain and fever to dysphagia and possible abscess formation. Broad-spectrum antibiotics are the primary treatment; however, surgical drainage may be necessary for abscesses to prevent systemic infection. Following acute management, identifying underlying anomalies such as branchial arch defects that predispose to recurrence is crucial. Diagnostic tools like barium swallow or transnasal fiberoptic laryngoscopy aid in this identification process. Recurrent AST or left-sided neck abscesses often prompt investigation for fourth branchial arch anomalies like pyriform sinus fistula, which may require surgical correction to prevent future infections. This paper presents the case of a 5-year-old with left torticollis, odynophagia, and fever, previously treated for a deep neck abscess with antibiotics. Ultrasound and CT scans revealed a left thyroid lobe abscess, confirmed by barium swallow to be associated with a pyriform sinus fistula. Supported by a literature review, this case highlights the importance of a systematic approach to AST management to guide clinicians in effectively treating this uncommon condition.