CASE REPORT
Diphtheria-like illness disguised as Kawasaki disease: Case report
 
More details
Hide details
1
Students’ Scientific Group of Department of Paediatric Pulmonology and Rheumatology, Medical University of Lublin, 20-093 Lublin, Poland
 
2
Department of Paediatric Pulmonology and Rheumatology, Medical University of Lublin, 20-093 Lublin, Poland.
 
These authors had equal contribution to this work
 
 
Submission date: 2024-12-09
 
 
Final revision date: 2025-01-11
 
 
Acceptance date: 2025-01-11
 
 
Online publication date: 2025-09-24
 
 
Corresponding author
Weronika Kopyt   

Students’ Scientific Group of Department of Paediatric Pulmonology and Rheumatology, Medical University of Lublin, Gębali 6, 20-093 Lublin, Poland.
 
 
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Diseases caused by Corynebacterium spp. are rare in humans. The atypical clinical presentation of the infection may cause diagnostic difficulties.

Aim:
In this case report, we present the medical history of a 3-year-old patient admitted to the hospital with symptoms characteristic of Kawasaki disease.

Case study:
The child presented with a persistent fever, a red throat, conjunctival hyperaemia, enlargement of the submandibular and cervical nodes, maculopapular rash on the trunk. In the laboratory tests the significant elevation of inflammatory markers, an increased plasma concentration of N-terminal pro B-type natriuretic peptide (NT-proBNP) were observed. Additionally, the girl was not fully vaccinated. Despite the administration of antibiotic therapy, the patient's general condition deteriorated. Irregularities in heart rhythm were also noticed. For these reasons, the patient was transferred to a tertiary reference hospital. Although the criteria for Kawasaki disease were met, due to the persistent coating on both tonsils and pharynx, further diagnostics were deemed necessary. A microbiological examination revealed the cultivation of coryneform bacteria. Appropriate antibiotic treatment led to the improvement of the girl's condition.

Results and discussion:
The described case indicates two important pediatric problems. The first one concerns the diagnosis of fevers with atypical symptoms related to rare infections. The second one concerns the similarity of symptoms of infections and Kawasaki disease.

Conclusions:
Attention should be paid to the atypical course of infection, which may mimic other diseases. In the differential diagnosis, it is worth considering opportunistic infections, rare microorganisms.
FUNDING
None declared.
CONFLICT OF INTEREST
None declared.
REFERENCES (35)
1.
de Steenhuijsen Piters WAA, Binkowska J, Bogaert D. Early Life Microbiota and Respiratory Tract Infections. Cell Host Microbe. 2020;28(2):223–232. https://doi.org/10.1016/j.chom....
 
2.
Andrade BGN, Cuadrat RRC, Tonetti FR, Kitazawa H, Villena J. The role of respiratory microbiota in the protection against viral diseases: respiratory commensal bacteria as next-generation probiotics for COVID-19. Biosci Microbiota Food Health. 2022;41(3):94–102. https://doi.org/10.12938/bmfh.....
 
3.
De Boeck I, Wittouck S, Wuyts S, et al. Comparing the Healthy Nose and Nasopharynx Microbiota Reveals Continuity As Well As Niche-Specificity. Front Microbiol. 2017;8:2372. https://doi.org/10.3389/fmicb.....
 
4.
Kanmani P, Clua P, Vizoso-Pinto MG, et al. Respiratory Commensal Bacteria Corynebacterium pseudodiphtheriticum Improves Resistance of Infant Mice to Respiratory Syncytial Virus and Streptococcus pneumoniae Superinfection. Front Microbiol. 2017;8:1613. https://doi.org/10.3389/fmicb.....
 
5.
Pettigrew MM, Laufer AS, Gent JF, Kong Y, Fennie KP, Metlay JP. Upper respiratory tract microbial communities, acute otitis media pathogens, and antibiotic use in healthy and sick children. Appl Environ Microbiol. 2012;78(17):6262–6270. https://doi.org/10.1128/aem.01....
 
6.
Teutsch B, Berger A, Marosevic D, et al. Corynebacterium species nasopharyngeal carriage in asymptomatic individuals aged ≥ 65 years in Germany. Infection. 2017;45(5):607–611. https://doi.org/10.1007/s15010....
 
7.
Valdoleiros SR, Sousa Neves C, Abranches Carvalho J, et al. Infection and colonization by Corynebacterium pseudodiphtheriticum: a 9-year observational study in a university central hospital. Eur J Clin Microbiol Infect Dis. 2020;39(9):1745–1752. https://doi.org/10.1007/s10096....
 
8.
de Graeff N, Groot N, Ozen S, et al. European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease – the SHARE initiative. Rheumatology (Oxford). 2019;58(4):672–682. https://doi.org/10.1093/rheuma....
 
9.
McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation. 2017;135(17):e927–e999. https://doi.org/10.1161/cir.00....
 
10.
Nakamura A, Ikeda K, Hamaoka K. Aetiological Significance of Infectious Stimuli in Kawasaki Disease. Front Pediatr. 2019;7:244. https://doi.org/10.3389/fped.2....
 
11.
Rowley AH. Is Kawasaki disease an infectious disorder? Int J Rheum Dis. 2018;21(1):20–25. https://doi.org/10.1111/1756-1....
 
12.
Gherardi G, Di Bonaventura G, Pompilio A, Savini V. Corynebacterium glucuronolyticum causing genitourinary tract infection: Case report and review of the literature. IDCases. 2015;2(2):56–58. https://doi.org/10.1016/j.idcr....
 
13.
Neemuchwala A, Soares D, Ravirajan V, Marchand-Austin A, Kus JV, Patel SN. In Vitro Antibiotic Susceptibility Pattern of Non-diphtheriae Corynebacterium Isolates in Ontario, Canada, from 2011 to 2016. Antimicrob Agents Chemother. 2018;62(4):e01776-17. https://doi.org/10.1128/AAC.01....
 
14.
Reddy K, Gericke S, Rabie H, Pienaar C, Maloba M. Exudative pharyngitis and Corynebacterium pseudodiphtheriticum: A case report and review of the literature. S Afr J Infect Dis. 2021;36(1):225. https://doi.org/10.4102/sajid.....
 
15.
Guerrero J, Mallur P, Folch E, et al. Necrotizing tracheitis secondary to corynebacterium species presenting with central airway obstruction. Respir Care. 2014;59(1):e5–8. https://doi.org/10.4187/respca....
 
16.
Furiasse D, Gasparotto AM, Monterisi A, Castellano G, Rocchi M. [Pneumonia caused by Corynebacterium pseudodiphtheriticum]. Rev Argent Microbiol. 2016;48(4):290–292. https://doi.org/10.1016/j.ram.....
 
17.
Wallet F, Vanagt S, Alaoui M, et al. An unusual case of native aortic endocarditis due to Corynebacterium pseudodiphtheriticum. New Microbiol. 2023;46(2):223–225.
 
18.
Duignan ES, Farrell S, Treacy MP, et al. Corneal inlay implantation complicated by infectious keratitis. Br J Ophthalmol. 2016;100(2):269–273. https://doi.org/10.1136/bjopht....
 
19.
Erturan G, Holme H, Iyer S. Corynebacterium pseudodiphtheriticum septic arthritis secondary to intra-articular injection--a case report and literature review. J Med Microbiol. 2012;61(Pt 6):860–863. https://doi.org/10.1099/jmm.0.....
 
20.
Goda T, Watanabe K, Kobayashi J, Nagai Y, Ohara N, Takahashi D. [A case of hyperammonemia with obstructive urinary tract infection by urease-producing bacteria]. Rinsho Shinkeigaku. 2017;57(3):130–133. https://doi.org/10.5692/clinic....
 
21.
Zasada AA, Mosiej E. Contemporary microbiology and identification of Corynebacteria spp. causing infections in human. Letters in Applied Microbiology. 2018;66(6):472–483. https://doi.org/10.1111/lam.12....
 
22.
Milosavljevic MN, Milosavljevic JZ, Kocovic AG, et al. Antimicrobial treatment of Corynebacterium striatum invasive infections: a systematic review. Revista do Instituto de Medicina Tropical de São Paulo. 2021;63. https://doi.org/10.1590/S1678-....
 
23.
Van Roeden SE, Thijsen SF, Sankatsing SUC, Limonard GJM. Clinical relevance of Corynebacterium pseudodiphtheriticum in lower respiratory tract specimens. Infect Dis (Lond). 2015;47(12):862–868. https://doi.org/10.3109/237442....
 
24.
Nhan TX, Parienti JJ, Badiou G, Leclercq R, Cattoir V. Microbiological investigation and clinical significance of Corynebacterium spp. in respiratory specimens. Diagn Microbiol Infect Dis. 2012;74(3):236–241. https://doi.org/10.1016/j.diag....
 
25.
Kobayashi SD, Malachowa N, DeLeo FR. Neutrophils and Bacterial Immune Evasion. Journal of Innate Immunity. 2018;10(5–6):432–441. https://doi.org/10.1159/000487....
 
26.
Roy S, Marla S, Praneetha D. Recognition of Corynebacterium pseudodiphtheriticum by Toll-like receptors and up-regulation of antimicrobial peptides in human corneal epithelial cells. Virulence. 2015;6(7):716–721. https://doi.org/10.1080/215055....
 
27.
Ott L, Möller J, Burkovski A. Interactions between the Re-Emerging Pathogen Corynebacterium diphtheriae and Host Cells. International Journal of Molecular Sciences. 2022;23(6):3298. https://doi.org/10.3390/ijms23....
 
28.
Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018;9. doi:10.3389/fimmu.2018.00754.
 
29.
Souza MC, dos Santos LS, Sousa LP, et al. Biofilm formation and fibrinogen and fibronectin binding activities by Corynebacterium pseudodiphtheriticum invasive strains. Antonie Van Leeuwenhoek. 2015;107:1387–99. https://doi.org/10.1007/s10482....
 
30.
Burkovski A. Corynebacterium pseudodiphtheriticum: putative probiotic, opportunistic infector, emerging pathogen. Virulence. 2015;6:673–674. https://doi.org/10.1080/215055....
 
31.
Choi Y, Lee JH. Clinical usefulness of NT-proBNP as a prognostic factor for septic shock patients presenting to the emergency department. Sci Rep. 2024;14(1):10999. https://doi.org/10.1038/s41598....
 
32.
Li N, Zhang Y, Fan S, Xing J, Liu H. BNP and NT-proBNP levels in patients with sepsis. Front Biosci (Landmark Ed). 2013;18(4):1237–1243. https://doi.org/10.2741/4175.
 
33.
Kang JM, Jung J, Kim YE, et al. Temporal Correlation Between Kawasaki Disease and Infectious Diseases in South Korea. JAMA Netw Open. 2022;5(2):e2147363. https://doi.org/10.1001/jamane....
 
34.
Hara T, Yamamura K, Sakai Y. The up-to-date pathophysiology of Kawasaki disease. Clin Transl Immunology. 2021;10(5):e1284. https://doi.org/10.1002/cti2.1....
 
35.
Rigante D. Kawasaki Disease as the Immune-Mediated Echo of a Viral Infection. Mediterr J Hematol Infect Dis. 2020;12(1):e2020039. https://doi.org/10.4084/MJHID.....
 
Journals System - logo
Scroll to top