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Cardiac diphtheria in a previously immunized individual
Loreli Munford1, Jennifer Jones, Lorena Landrum
1Medical College of Virginia, Virginia Commonwealth University, USA.
Journal of the National Medical Association
|October 7, 2003
Summary
A severe case of diphtheria caused acute respiratory distress and cardiac dysfunction in a young woman. Prompt treatment with antitoxin and antibiotics led to rapid recovery of heart function and gradual improvement of other symptoms.
Area of Science:
- Infectious Diseases
- Cardiology
- Otolaryngology
Background:
- Diphtheria, a vaccine-preventable disease, can cause severe complications.
- This case highlights the potential for rapid progression and multi-organ involvement.
Observation:
- A previously healthy 19-year-old female presented with severe pharyngitis, progressing to acute respiratory distress and laryngeal edema.
- Initial cardiac evaluation revealed severe global systolic dysfunction (EF 10-20%) with a possible cardiac thrombus.
- Throat culture confirmed Corynebacterium diphtheriae infection.
Findings:
- Treatment with diphtheria antitoxin resulted in prompt resolution of cardiac symptoms and improved ejection fraction (EF) to 65% within five days.
- Secondary infections and neurological complications (ocular motor neuritis, otitis media, strep. pneumonia) were treated with antibiotics.
- The patient required an urgent tracheostomy due to respiratory compromise.
Implications:
- This case underscores the critical importance of diphtheria immunization and prompt recognition of its severe manifestations.
- Early antitoxin administration is crucial for preventing irreversible cardiac damage and improving outcomes.
- Multidisciplinary management involving infectious disease, cardiology, and ENT specialists is essential for comprehensive patient care.