Diphtheritic polyneuropathy: Not so uncommon

Diphtheria is a potentially fatal infection owing to its life-threatening complications of respiratory obstruction and myocarditis. Less often reported is diphtheritic polyneuropathy (DP), which refers to signs and symptoms of various cranial nerve involvement and/or limb neuropathy within six weeks of a compatible clinical illness suggestive of diphtheria. We report four cases of DP occurring in a limited outbreak of 19 cases and review the literature. The most common cranial nerves affected were VII, IX and X. Importantly, all four cases had received their infant vaccinations. Diphtheria antitoxin and prednisolone were the mainstay of management in addition to physiotherapy support. All were discharged home and have made a good recovery. We conclude that DP is not so uncommon and its occurrence among children who had been vaccinated requires a review of the vaccination programme and schedules.