DR.MOHAMMED IRFAN SHEIKHabout 5 years ago

Diphtheria

A 14-year-old girl living in Nepal presented to the emergency department with a 3-day history of neck swelling, fever, throat pain, and difficulty swallowing. She appeared sick and had a swollen neck (Panel A), and examination of the oropharynx revealed a grayish-white membrane (Panel B). According to her mother, the patient had received three doses of the diphtheria–pertussis–tetanus vaccine during her first year of life, with no additional doses. Diphtheria was suspected, and treatment with penicillin G and antidiphtheria serum was initiated. A throat culture grew Corynebacterium diphtheriae. On the third day of hospitalization, chest discomfort, palpitations, and elevated troponin I levels developed, along with electrocardiographic abnormalities, including a prolonged PR interval, ectopic beats, and ST-segment depression; these signs and symptoms aroused concern about diphtheria-associated myocarditis. Wide complex tachycardia subsequently developed. The patient continued to have ventricular arrhythmias despite receiving treatment in the pediatric intensive care unit, and she died 2 days later. Isolates that had been sent to the Centers for Disease Control and Prevention in the United States were confirmed by culture to be C. diphtheriae, and polymerase chain reaction confirmed the presence of the toxin gene.