A Case of Necrotizing Epiglottitis Due to Nontoxigenic Corynebacterium diphtheriae

Author:

Lake Jessica A.1,Ehrhardt Matthew J.2,Suchi Mariko3,Chun Robert H.4,Willoughby Rodney E.5

Affiliation:

1. Departments of Pediatrics,

2. Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee

3. Pathology,

4. Otolaryngology, and

5. Infectious Disease, Medical College of Wisconsin, Milwaukee, Wisconsin; and

Abstract

Diphtheria is a rare cause of infection in highly vaccinated populations and may not be recognized by modern clinicians. Infections by nontoxigenic Corynebacterium diphtheriae are emerging. We report the first case of necrotizing epiglottitis secondary to nontoxigenic C diphtheriae. A fully vaccinated child developed fever, poor oral intake, and sore throat and was found to have necrotizing epiglottitis. Necrotizing epiglottitis predominantly occurs in the immunocompromised host. Laboratory evaluation revealed pancytopenia, and bone marrow biopsy was diagnostic for acute lymphoblastic leukemia. Clinicians should be aware of aggressive infections that identify immunocompromised patients. This case highlights the features of a reemerging pathogen, C diphtheriae.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

Reference23 articles.

1. Centers for Disease Control and Prevention (CDC). Diphtheria. In: Pink Book. 12th ed. Atlanta, GA: Centers for Disease Control and Prevention; 2012:75–86. Available at: www.cdc.gov/vaccines/pubs/pinkbook/dip.html

2. Fatal respiratory tract diphtheria apparently caused by nontoxigenic strains of Corynebacterium diphtheriae.;Rakhmanova;Eur J Clin Microbiol Infect Dis,1997

3. World Health Organization (WHO). Diphtheria in Afghanistan. August 29, 2003. Available at: www.who.int/csr/don/2003_08_29/en

4. Infectious mononucleosis complicated by necrotizing epiglottitis, dysphagia, and pneumonia.;Biem;Chest,1989

5. Necrotizing epiglottitis and hemophagocytic lymphohistiocytosis.;Kong;Int J Pediatr Otorhinolaryngol,2009

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