UPPER AIRWAY OBSTRUCTION AND MYOCARDITIS DUE TO SEVERE DIPHTHERIA REPORT OF A SUCCESSFUL CASE IN AN UNIMMUNIZED 4-YEAR-OLD BOY
Fahrul Riza,Raihan Raihan
Syiah Kuala University
Background : Diphtheria is an infectious disease caused by Corynebacterium Diphtheria. It is a fatal disease due to complication on heart, renal, central nervous system and airway which require tracheostomy as result of local inflammation or by effect exotoxin. The most frequent cause of death is airway obstruction or suffocation following aspiration of the pseudomembrane.
Case Presentation Summary : An unimmunized 4-year-old boy was admitted to Dr. Zainoel Abidin hospital with upper airway obstruction and a history four days fever and sore throat. Physical examination revealed stridor inspiratoir with Jackson grade 3-4, both tonsils and uvula covered by pseudomembrane. Tracheostomy was performed immediately by the ENT team. The patient was also treated with Penicillin Procaine intramuscularly and 70.000 IU ADS due to its limited availability. On tenth days of illness the patient suffered from myocarditis, then corticosteroid was added to the treatment. This condition improved after one week, and tracheostomy tube was removed on the 14th days of admission. The patient was fully recovered and was discharged after 15 days of admission. The throat swab culture, unfortunately was not confirmed for Corynebacterium Diphtheria.
Learning Points/Discussion : The most severe complication of diphtheria is airway obstruction followed by death. Meanwhile, myocarditis is the most common complication varies from asymptomatic to complete heart block. In this case the patient immediately performed tracheostomy since suffered from upper airway obstruction, while myocarditis became better with supportive treatment. The patient survive and discharge from the hospital with fully recovery.
Keywords: severe diphtheria upper airway obstruction myocarditis
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