A 11 year old female child brought with respiratory distress with stridor emergency tracheostomy was done identify the case


Most probable diagnosis here is diphtheria.. Bull neck appearance is present. Ask about immunization history. Antitoxin is the main stay of therapy here. Start Crystalline penicillin.
i saw bull neck case for the first time good sir.

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Agree with Dr Puneet Anand. Just to add that the picture is taken very nicely, apriciate the toxic look and bull's neck appearance. Airway obstruction and air hunger is mostly due to mitis variety of Corynaebacterium diptheriae. Diphtheria is always a clinical diagnosis and treatment should be started immediately and one should not wait for Lab reports, to reduce mortality and morbidity. Lab will only add support to clinical diagnosis. Congrats to Dr. A Mujeeb for this post, because it is now rarely seen in many parts of India, so this post will be very much helpful for young junior doctors who may not have seen a single case in there Internship and or Housestafship. Thanks a lot.
I have sent side pic just to make u all observe how a bull neck appearance looks like stridor with bull neck lymphadenopathy is a sure shot of classical diphtheria with out any obvious doubt she had faucial diphtheria after tracheostomy stridor subsided
pls post side pic also as I have never seen such a patient

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Dr Abdul Why the hair cut, I see this to prevent Pediculosis infestation in inmates of special homes, Enamel damage may be due to teeth grinding . Oral Commissures erosion due to excess saliva drooling. Paranasal infection with erosion. Diagnosis : Acute upper respiratory tract infection causing Stridor Possibly in a child from a special care home May be Down's syndrome.
Diphtheria, pertussis, group A Strep. Nasopharyngeal sampling should sent for CULTURE and PCR assay along with other investigations.

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with this much of history and pictures there are a lot of causes arising in mind viz foreign body lodgement,food allergy,insect bite etc etc. if more is present plz share with us. dont mind but trechiostomy tube placement is poor as its not fixed properly and just tied around the neck with may slip aside and come out.
Child developed fever and dysphagia from 3 days stridor since one day on examination whitish patches over tonsils and pillars and narrowing of oral cavity child is in toxic shock with feeble pulse and barely opening her mouth and was brought in stages of gasping I agree about poor placement of tube coz it was done at night 3 am and ours is exclusives govt Ent hospital so we referred quickly to paediatrician

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bull neck examine oral cavity fr membrane throat swab fr KLB immediately start antitoxin in icu setup to keep watch for potential complications..
Laryngeal diphtheria emergency tracheotomy give anti diphtheric serum and crystalline penicillin
most likely case of diphtheria, immunization history and throat examination is helpful
if is associated with fever definitely diphtheria otherwise juvenile pappilloma
Thank you DR ABDUL classical case of diphtheria.
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