TOXIC DIPHTHERIA CAUSED BY CORYNEBACTERIU M ULCERANS

A 42-year-old woman with bronchial asthma since childhood was admitted to hospital because of severe dyspnoea. Emergency bronchoscopic intub ation had to be performed for Life-threatening inspiratory and expirat ory strider. This demonstrated that the larynx was covered by a dirty- grey membrane and the vocal-cord gap was narrowed to a mere slit. As l aryngeal diphtheria was suspected 2000 IU/kg diphtheria antitoxin was administered together with 1 mega U penicillin G four times daily intr avenously. On the same day, Corynebacterium ulcerans, a very rare caus e of diphtheria, was isolated from a coughed-up piece of the membrane. Toxic, massive swelling of the lymphnodes and soft tissues of the nec k necessitated maintenance of an open upper airway by intubation and ( later) tracheostomy for 41 days. A week later the patient was discharg ed without any permanent defect.