When I was on my Pediatrics Infectious Diseases rotation, the attending physician with whom I was working and I went to see a patient who was recently admitted. Earlier, the inpatient pediatrics resident had called and informed us that this nine-year-old with cystic fibrosis had been exposed to a relative with diphtheria.
Diphtheria is a devastating disease caused by the bacteria, Corynebacterium diphtheriae. It presents with pharyngitis and massive swelling of the cervical lymph nodes, resulting in a “bull’s neck” appearance, and can ultimately cause respiratory distress, myocarditis, and neurologic and renal problems.
With these complications, the attending was worried but intrigued. Here’s the thing: in his 20+ years of training and practice, some of which took place in a developing country, he had never seen a single case of diphtheria. Further, due to vaccinations, it has been virtually eradicated in the United States since the 1980’s. In fact, between 2010 to 2015, there have only been two diagnosed cases in the U.S. Even more, he had not received a notification of a single report or outbreak in the region or country.
Curious, we went to go talk to the family. The patient’s mother told us that the child’s uncle was undergoing chemotherapy for leukemia and was told he has diphtheria. Delving further into the story, we found out that the uncle was being treated at the same hospital. With a glance at his electronic medical record, we found out that he had, in fact, not been found to be positive for Corynebacterium diphtheriae, but rather Diphtheroid epidermidis, a totally benign normal skin bacteria!
A simple miscommunication about similar sounding organisms had caused a ruckus on the pediatrics floor and a good laugh for us, but it was a good lesson: taking a good history can take you far!
