Subacute thyroiditis (also referred to as De Quervain thyroiditis) is a self-limited and transient inflammatory disorder of the thyroid gland.1 Although it is thought to be a virus-associated syndrome, the causal agent is rarely identified.2 Despite the strong erythroid tropism of erythrovirus B19 (EVB19), infection is also associated with thyroid disorders.3 We describe a rare case of EVB19-related subacute thyroiditis.
A 44-year-old Caucasian man with no previous medical history was referred to our internal medicine department for a 3-week febrile history (38.5°C), sore throat, myalgia and asthenia. Clinical examination revealed erythematous pharyngitis, tenderness to palpation of the thyroid (of normal size and non-nodular structure), and painful palpation of the proximal joints.
Laboratory findings revealed normal complete blood cell count, moderate inflammatory syndrome (C-reactive protein 54 mg/L, fibrinogen 6.2 g/L), normal renal and liver functions, high free T3 of 8 pmol/L (3.1-6.8), high free T4 of 26 pmol/L (12-22), undetectable thyroid-stimulating hormone (TSH) of 0.05 mIU/L (0.27-4.2), and high level of serum thyroglobulin 497 ng/mL (2-70). Microbiological samples (blood, urine cultures, and throat swab) were negative. The EVB19 serology (immunoglobulin M and G) and polymerase chain reaction (PCR) were positive. No TSH-receptor blocking, anti-thyroglobulin, and anti-thyroperoxidase antibodies were detected. Thyroid ultrasound examination showed bilateral hypoechoic areas and a relative diffuse decrease of vascularity across the gland without any nodules. Iodine-123 scintigraphy did not detect any radiotracer trapping (Figure). No specific treatment was started because symptoms were mild and improved spontaneously.
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-Myriam Chiaruzzi, MD, Robin Arcani, MD, Karin Mazodier, MD, Rodolphe Jean, MD, Pierre-Jean Weiller, MD, Gilles Kaplanski, MD, PhD, Pierre André Jarrot, MD, PhD
