title: Severe group a streptococcus surgical site infection after thyroid lobectomy.
abstract: BACKGROUND
  Thyroidectomy is rarely complicated by a surgical site infection (SSI). Despite its low incidence, post-thyroidectomy SSI is especially concerning because of its proximity to vital head and neck structures and the very real potential for airway compromise and death. Severe SSIs frequently are caused by Group A Streptococcus (GAS) because of its potential for developing into necrotizing fascitis. No description of the surgical approach to a necrotizing soft-tissue infection after thyroid resection is available in the current literature.
  
  
  METHODS
  Case report and review of the pertinent English-language literature.
  
  
  RESULTS
  A 47-year-old male underwent a right thyroid lobectomy and isthmusectomy for a follicular neoplasm. On post-operative day 2, the patient presented to the emergency department with persistent pain, rapid onset of swelling, and airway compromise shown on computed tomography scan. Emergency incision and drainage revealed a severe soft tissue infection. Because of subsequent worsening erythema and soft-tissue swelling, the patient had to be re-explored. The infection, later identified as caused by GAS, might have been transmitted from the patient's daughter.
  
  
  CONCLUSIONS
  To our knowledge, this is the first case reported of exposure to a family member with GAS pharyngitis. Successful treatment requires an appropriately high level of suspicion followed by emergent operative debridement and systemic antibiotics.
authors.affiliation: Alpert Medical School of Brown University, Providence, Rhode Island 10014, USA. Joelle.Karlik@brown.edu
authors.forename: Joelle B
authors.initials: JB
authors.lastname: Karlik
authors.forename: Vincent
authors.initials: V
authors.lastname: Duron
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Mermel
authors.forename: Peter
authors.initials: P
authors.lastname: Mazzaglia
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D013290:Streptococcal Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification* / Q000472:pathogenicity; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology*; D013965:Thyroidectomy / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents