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Myocardial complications of cutaneous diphtheria

1946; Elsevier BV; Volume: 31; Issue: 6 Linguagem: Inglês

10.1016/0002-8703(46)90501-7

1097-6744

Calvin F. Kay, Clarence S. Livingood,

Antimicrobial Resistance in Staphylococcus

1. The myocardial complications which developed in a group of 140 patients with cutaneous diphtheria have been considered. 2. Shortly after cutancous diphtheria was first observed in this hospital we became impressed with the gravity of the myocardial complications, and measures were instituted in an effort to recognize this complication early and to prevent death from this cause. The measures adopted may have been more stringent than necessary. 3. Definite myocarditis appeared in four patients, one of whom died. The diagnosis was considered probable in three additional patients, an incidence of 5 per cent. In seven other patients the diagnosis could not be exeluded entirely. 4. The symptoms, signs, laboratory studies, and electrocardiographic findings in these patients are discussed. 5. Cardiac complications developed from the fourth to seventh week after the onset of the skin lesions. Their duration was from one to three months. All patients who survived showed no evidence of cardiac abnormality after four and one-half months from the onset of the skin lesions. The electrocardiograph is an essential in the diagnosis and evaluation of the myocarditis. 6. A definite parallel relationship existed between the severity of the cutaneous lesions and development of cardiac complications. Of 18 patients with very severe cutaneous diphtheria, four (22 per cent) developed myocarditis: whereas the complication did not appear in any of the 50 patients in whom the cutaneous lesions were mild. 7. Neuritis developed as a complication in the three patients with definite myocarditis who survived, and in one of the three patients in whom the diagnosis of myocarditis was probable. The onset of neuritis either preceded, or coincided with, or followed the onset of the myocarditis. 8. It is concluded that myocarditis is an infrequent complication of cutaneous diphtheria, but one which must be especially considered in any patient in whom the degree of cutaneous involvement is severe.