A Case of Life-Threatening Airway Obstruction Caused by Acute Diphtheria Infection in the United Kingdom

Abstract

Diphtheria is a highly contagious and potentially life-threatening infection. Cases in the United Kingdom are rare due to widespread vaccination. However, in recent years, there has been a notable increase in cases in the United Kingdom. We present the case of a 76-year-old British Caucasian female who presented to the Emergency Department with shortness of breath and “chest tightness.” She reported a five-day history of worsening sore throat, odynophagia, and aphonia. On inspection, she had noisy, laboured breathing with the use of her accessory muscles. Flexible laryngoscopy revealed purulent, thick yellow discharge in the nasal cavity, oropharynx, and supraglottis, with oedema of the subglottic mucosa. She became increasingly breathless and was peri-arrest when emergency orotracheal intubation was performed. She was transferred to the Intensive Care Unit for ventilatory support and intravenous antibiotics. Four days after presentation, her microbiology results confirmed toxigenic Corynebacterium ulcerans. Public Health England was informed immediately. The patient was isolated and contact tracing was commenced. Thirty staff members were required to self-isolate and take prophylactic antibiotics due to close patient contact. It was particularly noteworthy that our patient was a UK national with no recent history of foreign travel. This case demonstrates the importance of remaining vigilant to atypical causes of airway obstruction secondary to infection. Early suspicion and prompt patient isolation may prevent community and occupational transmission and minimise the impact of contact tracing on hospital staffing. Migration from endemic countries and declining childhood vaccination rates may lead to a further rise in UK cases of diphtheria in the future.