Actinomycotic abscess of the thyroid gland is rare especially in childhood. In this article, we report the second pediatric case in literature, at age of 18 months. Although spread of actinomycotic infection to the thyroid gland from upper aerodigestive tract by preformed pathways such as piriform sinus fistula seems rational, it was demonstrated neither in current nor in previous cases. Therefore, further work-up such as barium swallow, which is onerous to perform in a child may be reserved for recurrent cases. (c) 2004 Elsevier Ireland Ltd. All rights reserved.