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Unexpected combination of acute croup and myocarditis: case report
George Briassoulis1, Athina Tsorva, Emmanuel Agapitos
1Pediatric Intensive Care Unit, P & A Kyriakou Children's Hospital, Athens, Greece. ggbriass@otenet.gr
Insights
This case report highlights a resurgence of diphtheria in a foreign-born child, emphasizing the need for updated infectious disease pathology training for clinicians and pathologists to manage imported diseases effectively.
Area of Science:
- Pediatric Infectious Diseases
- Pathology
- Immunology
Background:
- Lower vaccination rates in foreign-born children increase infectious disease risk.
- Imported infectious diseases are rising in developed nations.
- Clinicians and pathologists require updated infectious disease pathology expertise.
Purpose of the Study:
- To report a case of diphtheria in a foreign-born child.
- To underscore the importance of recognizing and managing rare infectious diseases.
- To emphasize the need for enhanced pathology training.
Main Methods:
- Case presentation of a 3.5-year-old girl with severe respiratory distress.
- Diagnostic procedures included intubation, echocardiography, and autopsy.
- Microbiological analysis identified toxigenic Corynebacterium diphtheriae.
Main Results:
- The patient presented with croup, acute respiratory failure, and shock.
- Intubation revealed a laryngeal membrane; echocardiography showed acute myocarditis.
- Autopsy confirmed Corynebacterium diphtheriae infection.
Conclusions:
- Diphtheria is a re-emerging threat requiring clinical vigilance.
- Infectious disease pathology competence is crucial for new clinicians and pathologists.
- Active participation in diagnosing and investigating infectious diseases is essential.
Background:
Lower vaccination coverage among foreign-born children is of concern because they live in households and communities characterized by more intense exposure to infectious diseases. Because of their higher prevalence rates, there is an increasing occurrence of infectious diseases imported into developed countries. This case report emphasizes the emerging necessity for new clinicians and pathologists of having competence with old infectious disease pathology.
Case Presentation:
A three and a half year old girl, who presented with croup history of 5 days and has been in severe respiratory distress, was admitted to the Pediatric Intensive Care Unit in shock and acute respiratory failure. The patient was immediately intubated, and a grayish nonadherent membrane extending through the glottis down into the larynx was apparent during the procedure. Echocardiographic findings, which were consistent with acute myocarditis, confirmed poor left ventricular contractility despite escalating high doses of inotropes. Autopsy showed numerous strains of toxigenic corynobacterium diphtheriae, which also grew on the Loeffler cultures of membranes received during the intubation.
Conclusion:
It is critical that new generations of clinicians and bio-pathologists not only be trained in the subspecialty of infectious disease pathology, but that they also be willing participants in the diagnosis and investigation of infectious diseases.
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