Subacute Thyroiditis: A Rare Cause of Pyrexia of an Unknown Origin.

Subacute thyroiditis is inflammation of the thyroid gland, classically presenting with neck pain or discomfort and sometimes with associated diffuse tender goiter and overt hyperthyroid symptoms. Only a few rare cases of subacute thyroiditis presenting as pyrexia of unknown origin (PUO) without any of the aforementioned clinical features have been reported in the literature. A 62-year-old male, with a past history of diabetes mellitus, presented with a history of intermittent fever lasting for one month duration. He did not have any significant localizing symptoms, except for a mild headache, and his examination findings were unremarkable as well. Investigations revealed a high erythrocyte sedimentation rate (ESR), high C-reactive protein (CRP) levels, and a deranged thyroid profile, with high free T3 and T4 and suppressed thyroid-stimulating hormone (TSH) levels, suggestive of subacute thyroiditis. The diagnosis was further reinforced by the findings of a supportive ultrasound scan of the neck. The patient was started on steroids, to which he showed a significant clinical and biochemical response. Here, we aim to highlight atypical presentations of subacute thyroiditis and the importance of early consideration of endocrine diseases in the workup of PUO, sometimes even in the absence of suggestive clinical features.

Lady Windermere Syndrome: A Rare Differential Diagnosis for Hemoptysis.

Mycobacterium avium complex (MAC) is often observed in immunocompromised individuals. However, when pulmonary MAC infection occurs in immunocompetent individuals, particularly elderly females, characteristically involving the middle lobe and lingula lobe of the lung, it is known as Lady Windermere syndrome (LWS). A 64-year-old female patient with no significant comorbidities presented with a history of low-grade intermittent fever and dry cough for one-month duration complicated with hemoptysis for two days. Her initial investigations and imaging were negative, except for the high-resolution CT (HRCT) finding of bronchiectasis involving the middle lobe and lingula lobe suggestive of MAC infection, which was further confirmed by positive sputum culture for MAC. LWS is a condition that is rarely encountered in clinical settings and seldom described in the literature. Especially in resource-limited settings, arriving at a diagnosis is further hindered by the scarce availability of advanced imaging such as HRCT. In clinical settings where pulmonary tuberculosis is endemic, the differentiation of the two conditions is of paramount importance as the treatment regimens for the two conditions are quite different.