Epidermoid cyst abscess of the neck masquerading as a thyroid abscess

Summary: In this case report, we describe a 37-year-old male who presented with fever and tender neck mass. Neck ultrasonography revealed a mixed echogenic multiloculated solid-cystic lesion containing turbid fluid and occupying the right thyroid region. Thyroid function tests showed subclinical hyperthyroidism. The patient was initially diagnosed with thyroid abscess and he was subsequently treated with percutaneous aspiration and i.v. antibiotics; however, his clinical symptoms did not improve. Surgical treatment was then performed and a pathological examination revealed a ruptured epidermoid cyst with abscess formation. No thyroid tissue was identified in the specimen. The patient was discharged uneventfully. However, at the 3-month and 1-year follow-ups, the patient was discovered to have developed subclinical hypothyroidism. Neck ultrasonography revealed a normal thyroid gland. This report demonstrates a rare case of epidermoid cyst abscess in the cervical region, of which initial imaging and abnormal thyroid function tests led to the erroneous diagnosis of thyroid abscess.

Learning points: Epidermoid cyst abscess at the cervical region can mimic thyroid abscess. Neck ultrasonography cannot distinguish thyroid abscess from epidermoid cyst abscess. Thyroid function may be altered due to the adjacent soft tissue inflammation.

Keywords: 2020; Abscess drainage; Abscess*; Adult; Amoxicillin; Antibiotics; Asian - other; CT scan; Clavulanic acid*; Dermatology; Dysphagia; Dysphonia; Epidermoid cyst*; Error in diagnosis/pitfalls and caveats; FT3; FT4; Fine needle aspiration biopsy; Glucocorticoids; Haematoxylin and eosin staining; Hemithyroidectomy*; Histopathology; Hyperthyroidism; Hypothyroidism; June; Leukocytosis; Male; Naproxen; Neck mass; Palpitations; Piperacillin*; Prednisolone; Pyrexia; Radiology/Rheumatology; Sore throat; Surgery; TSH; Tazobactam; Thailand; Thyroid; Thyroid function; Thyroiditis; Thyroxine (T4); Total T3; Tremulousness; Triiodothyronine (T3); Ultrasound scan; White blood cell count.