Diphtheria in a 13 year old adolescent girl: Management challenges

Abstract

Background: Diphtheria is an acute toxic infection which is associated with a high morbidity and mortality and can pose management challenges especially in the absence of proper diagnostic and therapeutic facilities.

Case report: A.S. was a 13 year old girl who presented with fever of five days duration, dysphagia and neck swelling of 4 days duration and sore throat and hoarse voice of 3days duration. Her illness started a day after returning from a 4-day holiday youth camp. She received only oral polio vaccine immunization in childhood. Significant physical examination
findings included a swollen neck, a greyish membrane covering the soft palate and uvula with haemorrhagic spots. The pharynx, anterior nares and the nasal turbinates were inflamed and erythematous. A working diagnosis of respiratory diphtheria was made. Throat swab microscopy showed club shaped Gram positive baccilli. Appropriate culture medium for C. diphtheria
was not available. She received intravenous crystalline penicillin and metronidazole and lateroral erythromycin in an isolated ward. On the 6th day of admission she developed cardiac and neurologic complications–
bradycardia (PR=40bpm), hypotension (BP=70/40mmHg), drooling of saliva and paraparesis. Electrocardiography confirmed a complete heart block. She died on the 11th day of admission while efforts were being made to raise funds for a cardiac pace maker.

Conclusion: Management of this vaccine preventable disease requires a high index of suspicion and diphtheria antitoxin should be made readily available.