Sir.—Abe et al raised the number of cases to my knowledge of recurrent acute suppurative thyroiditis reported in the literature from two to four (Am J Dis Child 132:990-991, 1978). A fifth case has occurred, which was particularly refractory to management both by antibiotics and by simple drainage.
Report of a Case.—A 1-year-old girl was noted to have acute onset of a swelling in the thyroid area, with thickening, tenderness, and redness of the overlying skin. A "bone-hard" mass was palpated, which felt like "two walnuts connected in the center." The swelling was preceded by an upper respiratory infection with profuse nasal discharge of one week's duration that was treated symptomatically. The patient's temperature was 39.0 °C and her WBC count was 19,000/cu mm. Results of all thyroid studies, including those of antibodies, were normal, and a thyroid scan showed very little trapping of isotope in the