Multidisciplinary approach to the management of a case of classical respiratory diphtheria requiring percutaneous endoscopic gastrostomy feeding

BMJ Case Rep. 2017 Mar 6:2017:bcr2016218408. doi: 10.1136/bcr-2016-218408.

Abstract

We present a case of a Caucasian woman aged 67 years referred with a 4-day history of sore throat, dysphagia, fever and nasal blockage. Examination revealed a swollen neck and pharyngeal pseudomembrane. A throat swab was positive on culture for Corynebacterium ulcerans, with toxin expression confirmed on PCR and Elek testing. A diagnosis of classical respiratory diphtheria was made, with subsequent confirmation of the patient's domesticated dog as the source of infection. The dog had recently been attacked by a wild badger and was being treated for an ear infection. The patient made a good recovery with intravenous antimicrobial and supportive therapy; however, she subsequently developed a diphtheritic polyneuropathy in the form of a severe bulbar palsy with frank aspiration necessitating percutaneous endoscopic gastrostomy feeding. A mild sensorimotor peripheral neuropathy was also diagnosed. The patient eventually made an almost complete recovery.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Animals
  • Anti-Infective Agents / therapeutic use*
  • Corynebacterium / genetics
  • Corynebacterium / isolation & purification*
  • Diphtheria / microbiology*
  • Diphtheria / therapy*
  • Diphtheria / transmission
  • Disease Management
  • Dog Diseases / microbiology
  • Dogs
  • Enteral Nutrition
  • Female
  • Gastrostomy
  • Humans
  • Lung Diseases / microbiology*
  • Lung Diseases / therapy*
  • Zoonoses / microbiology

Substances

  • Anti-Infective Agents