SEVERE DIPHTHERIA WITH COMPLETE HEART BLOCK A CASE REPORT
inayah muttaqin,herlina dimiati,raihan
Syiah Kuala University
Background : Diphtheria is an acute infectious upper respiratory tract disease caused by toxigenic strains of Corynebacterium diphtheriae. The toxin mediated disease affects multiple systems and cardiovascular involvement is a major contributor to the mortality. Cardiac manifestations include myocardial dysfunction as well as bradyarrhythmias and tachyarrhythmias; although the most feared one is complete heart block with almost all cases being fatal despite ventricular pacing.
Case Presentation Summary : An incompletely immunized nine-year-old boy was referred to dr. Zainoel Abidin hospital with pseudomembrane, and neck swelling. The patient had a history of low grade fever, severe sore throat, and dysphagia. Physical examination revealed bull neck and thick yellowish pseudomembrane on pharynx, tonsils, uvula extended to soft tissue palate. The ECG showed total atrioventricular block. The patient then was diagnosed as probable tonsilar pharyngeal diphtheria and complete heart block and was treated with ADS, penicillin, corticosteroid, dopamine and partial parenteral nutrition. Patient did not receive cardiac pace maker due to unavailability in our hospital. The cardiac complication improved after 12 days of treatment became dysritmia. During hospitalization patient also suffered from acute kidney insufficiency and recovery with supportive treatment. The throat swab culture showed positive result for Corynebacterium Diptheriae Toxigenic Type Mitis.
Learning Points/Discussion : Diphtheric myocarditis has an associated mortality rate of 80%, and it accounts for the majority of deaths related to diphtheria. If complete heart block develops, the prognosis is almost always death, but recovery has been reported in only a few cases. This patient suffered from complete heart block but survive although did not receive cardiac pace maker.
Keywords: severe diphtheria myocarditis complete heart block
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