Complete heart block due to diphtheritic myocarditis in the present era
A 5-year-old boy was referred to our outpatient clinic as a case of CHB. Forty days prior, he was admitted in a pediatric tertiary hospital with fever and neck swelling of seven days duration followed by bulbar symptoms, cranial nerve palsies, and respiratory difficulty. His ECG done was unremarkable except for sinus tachycardia although no echocardiography was done during the acute stage. He was diagnosed as a case of bulbar diphtheria and was given antiserum as well as antibiotics and other supportive measures. He required intubation and ventilator support for 15 days. Meanwhile his throat swab culture grew Corynebacterium diphtheriae thus confirming the diagnosis. Over the next month he showed significant improvement, but noted to have relatively slow heart rate while in hospital. A repeat ECG done revealed CHB with ventricular rate of 62 beats per minute and had narrow QRS escape []. As his neurological recovery was near complete he was discharged and referred to our center. An echo done then revealed mild left ventricle (LV) dysfunction with LVEF of 50% while ECG showed persistence of CHB. Hoping for recovery, it was decided to keep child on close medical follow-up as the he was asymptomatic. But even after five months, he continued to be in CHB and hence a pacemaker implantation was advised. This was not agreeable to the parents and he was lost to follow-up subsequently. The baseline features and investigation findings in the patients are summarized in Tables –.