{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T06:46:49Z","timestamp":1756190809987,"version":"3.37.3"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T00:00:00Z","timestamp":1725580800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T00:00:00Z","timestamp":1725580800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>This case report presents an exceptionally rare and atypical presentation of diphtheria in a 17-year-old female of Hausa ethnicity residing in an area with an elevated incidence within Kano State, Nigeria. By the end of 39th epidemiological week of 2023, only two cases of cutaneous diphtheria have been reported among 5,811 cases managed at MMSH diphtheria treatment center (DTC), representing approximately 0.035% of all diphtheria cases during that time period.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 17-year-old Hausa female presented with a 3-day history of throat discomfort, malaise, and muffled speech. Physical examination revealed a pseudomembrane covering the tonsillar pillars, grade 3 tonsillar enlargement, and an unusual genital manifestation characterized by extensive vulval edema, severe pain, and a large, greyish patch extending into the vaginal introitus. Her medical history was significant for recent exposure to diphtheria and the emotional impact of her sibling's death from the same disease. Diagnostic tests, including throat swab culture and histocytology, confirmed diphtheria in the throat and vulvovaginal regions. The patient was promptly initiated on diphtheria antitoxin, Azithromycin, and innovative sitz baths with hydrogen peroxide. After 4\u00a0days of Sitz bath therapy, complete pseudomembrane clearance was observed, and the patient's symptoms resolved.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This case underscores the complexity of diphtheria presentations, particularly with rare pseudomembranes in both throat and vaginal regions. The successful management, combining traditional and innovative therapies, highlights the importance of recognizing and addressing unusual manifestations promptly. The potential role of auto-inoculation and the efficacy of interventions like hydrogen peroxide sitz baths warrant further investigation. Overall, this case contributes to the understanding of diverse diphtheria presentations, guiding future clinical strategies for management of diphtheria cases and emphasizing the imperative of comprehensive vaccination efforts.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-024-04646-5","type":"journal-article","created":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T11:02:44Z","timestamp":1725620564000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rare manifestations of cutaneous diphtheria: a case report"],"prefix":"10.1186","volume":"18","author":[{"given":"Salma Ali","family":"Suwaid","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9683-2361","authenticated-orcid":false,"given":"Aliyu","family":"Mustapha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monika","family":"Ried","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruqayyah Ali","family":"Muhammad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aminu Shehu","family":"Liman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salma","family":"Yusuf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,9,6]]},"reference":[{"issue":"7","key":"4646_CR1","doi-asserted-by":"publisher","first-page":"2664","DOI":"10.1128\/JCM.00362-11","volume":"49","author":"CF Lowe","year":"2011","unstructured":"Lowe CF, Bernard KA, Romney MG. Cutaneous diphtheria in the urban poor population of Vancouver, British Columbia, Canada: a 10-year review. J Clin Microbiol. 2011;49(7):2664\u20136. https:\/\/doi.org\/10.1128\/JCM.00362-11.","journal-title":"J Clin Microbiol"},{"issue":"2","key":"4646_CR2","doi-asserted-by":"publisher","first-page":"187","DOI":"10.4103\/0378-6323.39728","volume":"74","author":"TP Vetrichevvel","year":"2008","unstructured":"Vetrichevvel TP, Pise GA, Agrawal KK, Thappa DM. Cutaneous diphtheria masquerading as a sexually transmitted disease. Indian J Dermatol Venereol Leprol. 2008;74(2):187. https:\/\/doi.org\/10.4103\/0378-6323.39728.","journal-title":"Indian J Dermatol Venereol Leprol"},{"issue":"2","key":"4646_CR3","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1093\/oxfordjournals.aje.a112145","volume":"102","author":"MA Belsey","year":"1975","unstructured":"Belsey MA, LeBlanc DR. Skin infections and the epidemiology of diphtheria: acquisition and persistence of C. diphtheriae infections. Am J Epidemiol. 1975;102(2):179\u201384. https:\/\/doi.org\/10.1093\/oxfordjournals.aje.a112145.","journal-title":"Am J Epidemiol"},{"issue":"10","key":"4646_CR4","doi-asserted-by":"publisher","first-page":"1834","DOI":"10.3201\/eid2510.190271","volume":"25","author":"KEN Clarke","year":"2019","unstructured":"Clarke KEN, MacNeil A, Hadler S, Scott C, Tiwari TSP, Cherian T. Global epidemiology of diphtheria, 2000\u201320171. Emerg Infect Dis. 2019;25(10):1834\u201342. https:\/\/doi.org\/10.3201\/eid2510.190271.","journal-title":"Emerg Infect Dis"},{"key":"4646_CR5","unstructured":"World Health Organization. Disease Outbreak News; Diphtheria \u2013 Nigeria. 2023. https:\/\/www.who.int\/emergencies\/disease-outbreak-news\/item\/2023-DON452"},{"key":"4646_CR6","unstructured":"Centers for Disease Control and Prevention. Diphtheria: clinicians. 2022. https:\/\/www.cdc.gov\/diphtheria\/clinicians.html"},{"issue":"9","key":"4646_CR7","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1016\/S1473-3099(15)00225-X","volume":"15","author":"LSP Moore","year":"2015","unstructured":"Moore LSP, Leslie A, Meltzer M, Sandison A, Efstratiou A, Sriskandan S. Corynebacterium ulcerans cutaneous diphtheria. Lancet Infect Dis. 2015;15(9):1100\u20137. https:\/\/doi.org\/10.1016\/S1473-3099(15)00225-X.","journal-title":"Lancet Infect Dis"},{"key":"4646_CR8","doi-asserted-by":"publisher","unstructured":"Vieira VV, Ramos JN, dos Santos LS, Mattos-Guaraldi, AL. (Corynebacterium: molecular typing and pathogenesis of\u00a0Corynebacterium diphtheriae\u00a0and zoonotic diphtheria toxin-producing\u00a0Corynebacterium\u00a0species. In: de Filippis, I. (eds) Molecular typing in bacterial infections, Volume I. 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N Engl J Med. 2018;378(13): e17. https:\/\/doi.org\/10.1056\/NEJMicm1701825.","journal-title":"N Engl J Med"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-024-04646-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-024-04646-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-024-04646-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T11:07:51Z","timestamp":1725620871000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-024-04646-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,6]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["4646"],"URL":"https:\/\/doi.org\/10.1186\/s13256-024-04646-5","relation":{},"ISSN":["1752-1947"],"issn-type":[{"type":"electronic","value":"1752-1947"}],"subject":[],"published":{"date-parts":[[2024,9,6]]},"assertion":[{"value":"17 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 June 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 September 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The ethical clearance for this study was obtained from hospital management board under the administration of Kano state, ministry of health.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient's legal guardian for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"433"}}