History of Illness:

A 6 year old boy had persistent "influenza"-like symptoms, and, after 10 days, developed a croupy cough and lost his voice. He was admitted to hospital. On examination, he was very sick, with marked "stridor" (harsh wheeze due to upper airway obstruction) and nasal discharge. "Tracheostomy" (inserting a breathing tube into the trachea below the obstruction) was performed, and a large fibrinous plug (derived from exuded plasma protein) was removed. He failed to respond to treatment, and died 2 days later. The bacterium Corynebacterium diphtheriae, which causes diphtheria, was grown from throat swabs. At autopsy, there was marked swelling of the neck, and on opening the trachea and main bronchi a plug of solid fibrinous matter was found just below the tracheostomy. Extending from the trachea along the main bronchi was a thick, tenacious exudate which practically occluded them. The myocardium of the left ventricle appeared mottled, and the spleen was twice the normal size.