title: A 9-year-old boy with severe diphtherial infection and cardiac complications.
abstract: The incidence of diphtheria has decreased since the introduction of an effective vaccine. However, in countries with low vaccination rates it has now become a re-emerging disease. Complications from diphtheria commonly include upper airway obstruction and cardiac complications. We present a 9-year-old boy who was diagnosed with diphtheria. He presented with fever, tonsilar plaques, respiratory failure and an incomplete vaccination history. He was endotracheal intubated and received diphtheria antitoxin and penicillin on the first day of hospitalisation. He developed progressive arrhythmias and fulminant myocarditis despite early identification and treatment with equine antitoxin and antibiotics. After a temporary transvenous pacemaker insertion due to third-degree atrioventricular block and hypotension for 1 week, he developed myocardial perforation from the pacemaker tip resulting in pericardial effusion. The treatment included emergency pericardiocentesis and pacemaker removal. His electrocardiogram showed a junctional rhythm with occasional premature ventricular complexes. He then developed ventricular tachycardia and cardiac arrest and finally died.
authors.affiliation: Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, USA.
authors.forename: Charles Henry
authors.initials: CH
authors.lastname: Washington
authors.affiliation: Faculty of Medicine, Chiang Mai, Thailand.
authors.forename: Satja
authors.initials: S
authors.lastname: Issaranggoon na ayuthaya
authors.affiliation: Faculty of Medicine, Chiang Mai, Thailand.
authors.forename: Krit
authors.initials: K
authors.lastname: Makonkawkeyoon
authors.affiliation: Faculty of Medicine, Chiang Mai, Thailand.
authors.forename: Peninnah
authors.initials: P
authors.lastname: Oberdorfer
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000992:Antitoxins / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D053840:Brugada Syndrome; D000075224:Cardiac Conduction System Disease; D002648:Child; D003353:Corynebacterium diphtheriae; D004165:Diphtheria / Q000150:complications* / Q000188:drug therapy; D004562:Electrocardiography; D017809:Fatal Outcome; D006323:Heart Arrest / Q000209:etiology; D006329:Heart Conduction System / Q000002:abnormalities* / Q000382:microbiology; D006736:Horses; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008297:Male; D009205:Myocarditis / Q000209:etiology* / Q000382:microbiology; D010138:Pacemaker, Artificial / Q000009:adverse effects; D010490:Pericardial Effusion / Q000209:etiology* / Q000601:surgery; D020519:Pericardiocentesis
chemical_list: D000900:Anti-Bacterial Agents; D000992:Antitoxins