Background
Diphtheria is an  acute infectious disease caused by Corynebacterium diphtheriae affects primarily the upper respiratory tract with the formation of greyish white pseudomembrane. Diphtheria can lead to a characteristic swollen neck and throat, or “Bull-neck”. The swollen throat is often accompanied by a serious respiratory condition. Delay in treatment increases morbidity and mortality. Management consists of the use of specific antitoxins and elimination of the causative organism.
Objective
We report a case of  tonsilopharyngeal and laryngeal diphtheria accompanied by bull neck  in an 7 year 1 month old boy
Case
A 7-year 1 month old boy was referred to the Dr. Wahidin Sudirohusodo Hospital  with a low-grade fever, sore throat due to painfull swallowing for 5 days. On examining the patient, we found his to be fever, tachypnea and in severe stridor. An examination of the oral cavity he  had bilateral grade III tonsils covered by a dirty greyish white membrane. Removal of this membrane provoked bleeding. The rest of the oropharynx could not be visualized.There is lympnode at colli region. His total leucocyte count was 23,300 / mm3 , with normal haemoglobin and platelet counts, muscle CK and CK-MB was normal. ECG recorded within normal limit. Patients treated with anti-diphtheria serum (SAD), a tibiotic, and steroids.
Conclusion
Symptoms of diphtheria begin with respiratory tract infection, with production of white-gray pseudomembrane.In severe cases can cause respiratory embarrassment and a bull-neck appearance. Early diagnosis and treatment have better outcome