NONTOXIC CORYNEBACTERIUM-DIPHTHERIAE SEPT ICEMIA AND ENDOCARDITIS IN A HEALTHY ADULT - THE FIRST CASE-REPORT AND A REVIEW OF THE LITERATURE

Corynebacterium diphtheriae septicaemia is rarely encountered, usually in very particular situations: children with severe congenital heart disease or after heart surgery. Rare cases have been reported in immun odepressed adults or drug addicts. We observed a case in a formerly he althy 41-year-old woman who was hospitalized for fever unresponsive to bacampicillin. In this patient, no portal of entry could be identifie d; there was no history of past surgery nor drug abuse. The patient wa s not immunodepressed and HIV serology was negative. The last antidiph theria vaccination had been given at the age of 12 years. Corynebacter ium diphtheriae var. metis was identified on five blood cultures. The in vitro Elek test revealed that the strain was non-toxic. Echocardiog raphy did not show any signs until the fourth examination performed 1 month after onset of fever and 15 days after initiating effective adap ted antibiotic treatment with amoxicillin-clavanic acid. Mitral vegeta tions with grade 2 regurgitation completely regressed after 5 weeks of treatment. After 5 months of follow-up, the patient is in good health and no mitral damage has been observed. This is to our knowledge the first case report of Corynebacterium diphtheriae in a formerly healthy adult. In the literature 12 other cases in adults all concerned immun odepressed subjects or drug abusers. The question is raised as to whet her Corynebacterium diphtheriae is undergoing mutation. The germ could persist as a commensal host and explain a certain number of the recen t observations in drug abusers and immunodepressed patients.