# New Diphtheria Outbreak in Europe: A Fulminant and Fatal Case of Respiratory Diphtheria in a 16-Year-Old Patient From Pakistan

## TL;DR

A 16-year-old girl from Pakistan with incomplete diphtheria vaccination died from severe respiratory diphtheria in Europe, highlighting the importance of early diagnosis and vaccination.

## Contribution

This case report highlights the rare but fatal progression of diphtheria in Europe and emphasizes the importance of vaccination and early treatment.

## Key findings

- The patient's incomplete vaccination status and delayed treatment contributed to fatal respiratory failure.
- Diphtheria should be considered in the differential diagnosis for unvaccinated or under-vaccinated individuals.
- Prompt administration of antibiotics and anti-diphtheria serum is critical to prevent severe outcomes.

## Abstract

Diphtheria is primarily a childhood disease that has become rare in Europe. It is caused by Corynebacterium bacteria and typically presents in two main clinical forms: respiratory and cutaneous. With timely treatment using antibiotics and anti-diphtheria serum, serious complications and deaths remain uncommon. In this case, a 16-year-old girl from Pakistan was admitted to the ED with pharyngitis but without fever or difficulty breathing. She had no significant medical history, and her vaccination status was incomplete or unknown. Initial treatment with antibiotics and anti-inflammatory medication was started. Twenty-four hours later, she was readmitted due to compensated respiratory failure caused by upper airway obstruction from severe tonsillar hypertrophy. A tonsillectomy and adenoidectomy were performed. However, following surgery, her respiratory condition worsened rapidly, progressing to acute respiratory distress syndrome that required invasive mechanical ventilation. Despite treatment, her condition deteriorated further, necessitating veno-venous extracorporeal membrane oxygenation. The patient developed multi-organ failure that was unresponsive to treatment and died on the sixth day of hospitalization. Autopsy revealed pseudomembranes in the proximal airways, and Corynebacterium diphtheriae was identified as the causative pathogen. This case underscores the critical importance of early recognition and appropriate management of diphtheria, a disease now rare in Europe. Prompt administration of antibiotics and anti-diphtheria serum is vital to reduce the risk of severe complications and mortality. Furthermore, it highlights the essential role of vaccination in preventing this disease. Finally, it is crucial to consider diphtheria in the differential diagnosis for patients with unknown or incomplete vaccination histories, such as refugees or asylum seekers.