{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T03:43:09Z","timestamp":1778038989580,"version":"3.51.4"},"reference-count":21,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2014,11,2]]},"abstract":"<jats:p>The incidence of diphtheria has decreased since the introduction of an effective vaccine. However, in countries with low vaccination rates it has now become a re-emerging disease. Complications from diphtheria commonly include upper airway obstruction and cardiac complications. We present a 9-year-old boy who was diagnosed with diphtheria. He presented with fever, tonsilar plaques, respiratory failure and an incomplete vaccination history. He was endotracheal intubated and received diphtheria antitoxin and penicillin on the first day of hospitalisation. He developed progressive arrhythmias and fulminant myocarditis despite early identification and treatment with equine antitoxin and antibiotics. After a temporary transvenous pacemaker insertion due to third-degree atrioventricular block and hypotension for 1\u2005week, he developed myocardial perforation from the pacemaker tip resulting in pericardial effusion. The treatment included emergency pericardiocentesis and pacemaker removal. His electrocardiogram showed a junctional rhythm with occasional premature ventricular complexes. He then developed ventricular tachycardia and cardiac arrest and finally died.<\/jats:p>","DOI":"10.1136\/bcr-2014-206085","type":"journal-article","created":{"date-parts":[[2014,11,20]],"date-time":"2014-11-20T07:19:56Z","timestamp":1416467996000},"page":"bcr2014206085","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["A 9-year-old boy with severe diphtherial infection and cardiac complications"],"prefix":"10.1136","volume":"2014","author":[{"given":"Charles Henry","family":"Washington","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satja","family":"Issaranggoon na ayuthaya","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krit","family":"Makonkawkeyoon","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peninnah","family":"Oberdorfer","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,11,20]]},"reference":[{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.1","unstructured":"World Health Organization. Mortality and burden of disease estimates for WHO member states in 2002. Geneva: Switzerland; 2002 [updated December 2004; cited February 2014]. http:\/\/www.who.int\/healthinfo\/statistics\/bodgbddeathdalyestimates.xls"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-48-1-146"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(29)90339-2"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(34)80043-1"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.5","first-page":"53","article-title":"A study on determinants of occurrence of complications and fatality among diphtheria cases admitted to ID and BG hospital of Kolkata","volume":"40","author":"Anima","year":"2008","journal-title":"J Commun Dis"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.6","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/20.5.1259"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.7","first-page":"155","article-title":"Predictors of outcome in patients with diphtheria receiving intensive care","volume":"43","author":"Jayashree","year":"2006","journal-title":"Indian Pediatr"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.8","doi-asserted-by":"publisher","DOI":"10.1086\/425305"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.9","doi-asserted-by":"publisher","DOI":"10.1007\/s004310050871"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.10","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1080\/02724936.2000.11748136","article-title":"Diphtheritic myocarditis: clinical and laboratory parameters of prognosis and fatal outcome","volume":"20","author":"Havaldar","year":"2000","journal-title":"Ann Trop Paediatr"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.11","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.72.2.190"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-474X.2006.00062.x"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(37)90892-5"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(30)90253-0"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.15","first-page":"352","article-title":"Clinical features of diphtheria in Thai children: a historic perspective","volume":"33","author":"Pancharoen","year":"2002","journal-title":"Southeast Asian J Trop Med Public Health"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.16","unstructured":"Division of Epidemiology, Ministry of Public Health, Thailand. Annual Epidemiological Surveillance Report, 2002\u20132012."},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.17","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(64)90268-6"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.18","first-page":"16","article-title":"Perforations of right heart chambers associated with electrophysiology catheters and temporary transvenous pacing leads","volume":"39","author":"Aliyev","year":"2011","journal-title":"Turk Kardiyol Dern Ars"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.19","doi-asserted-by":"publisher","DOI":"10.1136\/pmj.79.934.463"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2005.06.011"},{"key":"2025082802212700000_2014.nov20_1.bcr2014206085.21","doi-asserted-by":"publisher","DOI":"10.1086\/344176"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2014-206085","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:21:35Z","timestamp":1756372895000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2014-206085"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,11,20]]},"references-count":21,"alternative-id":["10.1136\/bcr-2014-206085"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2014-206085","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,11,20]]}}}