Diphtheritic Myocarditis in an Unvaccinated Child

• Published in: JACC. Case reports Vol. 30; no. 6; p. 102972
• Main Authors: Esmel-Vilomara, Roger, Figueras-Coll, Marc, Rosés-Noguer, Ferran, Balcells, Joan, Gran, Ferran
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 19.03.2025; Elsevier
• Subjects: Cardiovascular; diphtheria; diphtheria antitoxin; diphtheritic myocarditis; extracorporeal membrane oxygenation; Heart Failure and Cardiomyopathies; vaccination; ECMO; RV; diphtheria antitoxin; LV; DT; DTA; DTP3; diphtheritic myocarditis; extracorporeal membrane oxygenation; diphtheria; vaccination; VA-ECMO; WHO; World Health Organization; diphtheria-pertussis-tetanus; left ventricle; venoarterial-extracorporeal membrane oxygenation; right ventricle; diphtheria toxin
• ISSN: 2666-0849; 2666-0849
• DOI: 10.1016/j.jaccas.2024.102972

Diphtheria, a preventable yet potentially fatal childhood disease, remains a significant threat to unimmunized children, despite its decreased prevalence due to widespread vaccination. A 6-year-old unvaccinated Spanish boy presented with diphtheritic myocarditis. His condition rapidly deteriorated, leading to cardiogenic shock and ventricular tachycardia, necessitating the use of venoarterial extracorporeal membrane oxygenation and the international procurement of diphtheritic antitoxin (DAT). Myocarditis stands as the primary cause of mortality in diphtheria. Early DAT administration is crucial, but its effectiveness diminishes once the diphtheria toxin binds to tissues, and global accessibility may be challenging due to limited production. In scenarios of refractory cardiogenic shock, the employment of mechanical circulatory support, specifically with left cavity drainage systems, can be vital. Timely vaccination is crucial in preventing diphtheria-related fatalities. Global access to essential treatments like DAT remains a significant challenge. [Display omitted]