Peer-reviewed article
A complex case of diphtheria in a pediatric patient: complications of renal failure and myocarditis.
Abdullahi Ahmed Ahmed, Nasteha Mohamad Sheikh Omar, Ahmed Elmi Abdi, Idil Hirsi Ali, Farah Ali Ahmed ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a case report of a 6-year-old girl with severe diphtheria who developed life-threatening complications including kidney failure and heart inflammation. The child had incomplete vaccination against diphtheria and presented with fever, difficulty swallowing, and confusion. Despite treatment with antitoxin and antibiotics, the case demonstrates how dangerous diphtheria remains in populations with low immunization coverage. The report emphasizes that strengthening routine immunization programs is essential to prevent diphtheria-related deaths.
Key points
- Diphtheria remains a life-threatening disease in low- and middle-income countries with incomplete immunization coverage
- Myocarditis and acute kidney injury are toxin-mediated complications and leading causes of death from diphtheria
- Early diagnosis, laboratory confirmation, and immediate administration of antitoxin are critical for treatment
- The 6-year-old patient had incomplete vaccination against diphtheria, making her vulnerable to severe disease
- Strengthening routine immunization programs is identified as the most effective strategy to reduce diphtheria morbidity and mortality
Limitations
This is a single case report of one patient, so it cannot establish how common these complications are or provide data on intervention effectiveness across populations. The document does not provide outcome data on the patient's recovery or long-term prognosis.
Abstract
BACKGROUND: Diphtheria remains a life-threatening infectious disease in low- and middle-income countries, particularly where immunization coverage is incomplete. Severe complications such as myocarditis and acute kidney injury significantly increase mortality. Reporting rare and complex presentations is essential to improve early recognition and management. CASE PRESENTATION: We report the case of a 6-year-old girl who presented to the emergency department with five days of aphonia, odynophagia, progressive dysphagia, fever, confusion, and oliguria. On examination, she had cervical lymphadenopathy, pharyngeal pseudomembranes, and signs of systemic toxicity. Laboratory investigations demonstrated acute kidney injury with metabolic acidosis. Echocardiography revealed myocarditis with reduced ventricular function. The patient had incomplete vaccination against diphtheria. She was treated with diphtheria antitoxin, antibiotics, and supportive critical care. Despite aggressive management, the case illustrates the severe systemic complications of toxic diphtheria. DISCUSSION: Diphtheria is transmitted primarily via respiratory droplets and direct contact with infected lesions. Children in settings with poor vaccine coverage are particularly vulnerable to severe disease. Myocarditis and renal failure are toxin-mediated complications and are the leading causes of death. This case highlights the importance of early diagnosis, laboratory confirmation, and immediate administration of antitoxin. CONCLUSION: This case underscores the ongoing threat of diphtheria in under-immunized populations. Prompt recognition and treatment are essential to prevent fatal complications. Strengthening routine immunization programs remains the most effective strategy to reduce diphtheria-related morbidity and mortality.