Case history
Case history
A 63-year-old man, recently returned from a trip to Haiti, presents to the emergency department complaining of persistent sore throat and difficulty in swallowing. A rapid test for group A streptococcal antigens and a test for heterophile agglutinins are negative, and he receives oral amoxicillin/clavulanate. On the fourth day of illness, the patient returns to the emergency room with chills, sweating, restlessness, difficulty swallowing and breathing, nausea, and vomiting. On examination, he is afebrile but has stridor and a swollen neck. Expiratory wheeze and diminished breath sounds in the left lung base are noted. Arterial pO₂ is 88% on room air.
Other presentations
Cutaneous diphtheria is another common presentation of corynebacteria infection, and can be caused by toxigenic or nontoxigenic bacterial strains. It is characterized by a nonprogressive, superficial skin infection with a scaling rash, or nonhealing ulcers covered by gray-brown membranes.[2][3] Pain, tenderness, erythema, and exudate are typical features. Lesions often begin as lacerations, burns, or bites, with secondary infection by corynebacteria.[4] Rarely, systemic and respiratory manifestations have been reported in cutaneous diphtheria.[5] Involvement of mucocutaneous membranes (for example, ocular, external auditory, or genital) can also occur, with or without respiratory involvement. Nontoxigenic strains have also been reported to cause pyogenic arthritis or endocarditis.[6][7]
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