Aspiration of a Castor Oil Seed masquerading as Laryngeal Diphtheria in an Infant

Abstract

Foreign body aspiration in children often remains undetected because of misleading clinical findings. Young age and absence of the history of an aspiration episode may lead to a delayed diagnosis. A 6-month-old unimmunized boy presented with sudden onset low grade fever, aphonia and respiratory distress for 7 days. He was clinically diagnosed as a case of diphtheria and was treated accordingly. X-ray of neck and chest were normal. Direct laryngoscopy showed a brownish white membrane completely covering the vocal cords along with small punctate bleeding spots in the surrounding laryngeal wall. Thinking of a possibility of laryngeal diphtheria vs. any mass lesion in vocal cord he was posted for laryngoscopic examination under general anesthesia but before the procedure, he coughed out an oval shaped brownish white mass which was actually a thorny seed of castor oil. Though high incidence of diphtheria in the community, absence of a history of immunization and aspiration of a foreign body, radiolucent nature of the seed and young age of the patient favored the diagnosis of diphtheria, a high level of suspicion and constant vigil over clinical progress is necessary for the physician to prevent delayed diagnosis and subsequent complications.