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Open Access Case report

Unexpected combination of acute croup and myocarditis: Case report

George Briassoulis12*, Athina Tsorva3, Emmanuel Agapitos4 and John Papadatos1

Author Affiliations

1 Pediatric Intensive Care Unit, "P & A Kyriakou" Children's Hospital, Athens, Greece

2 Paediatric Intensive Care Unit, University Hospital of Heraklion, Crete, Greece

3 Microbiology and Transfusion Departments, NIMTS Hospital, Athens, Greece

4 Department of Pathology, School of Medicine, National University of Athens, Greece

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BMC Clinical Pathology 2005, 5:5  doi:10.1186/1472-6890-5-5

Published: 7 June 2005



Lower vaccination coverage among foreign-born children is of concern because they live in households and communities characterized by more intense exposure to infectious diseases. Because of their higher prevalence rates, there is an increasing occurrence of infectious diseases imported into developed countries. This case report emphasizes the emerging necessity for new clinicians and pathologists of having competence with old infectious disease pathology.

Case presentation

A three and a half year old girl, who presented with croup history of 5 days and has been in severe respiratory distress, was admitted to the Pediatric Intensive Care Unit in shock and acute respiratory failure. The patient was immediately intubated, and a grayish nonadherent membrane extending through the glottis down into the larynx was apparent during the procedure. Echocardiographic findings, which were consistent with acute myocarditis, confirmed poor left ventricular contractility despite escalating high doses of inotropes. Autopsy showed numerous strains of toxigenic corynobacterium diphtheriae, which also grew on the Loeffler cultures of membranes received during the intubation.


It is critical that new generations of clinicians and bio-pathologists not only be trained in the subspecialty of infectious disease pathology, but that they also be willing participants in the diagnosis and investigation of infectious diseases.