Postdiphtheritic Polyneuritis and Pseudodiphtheritic Polyneuritis

Abstract

THE SUCCESSFUL treatment of acute polyneuritis due to various known diseases and of the acute polyneuritis of unknown etiology, known as the Guillain-Barr\l=e'\ syndrome, has been effectively enhanced by the use of cortisone and corticotropin. The use of these agents has resulted in dramatic and life-saving improvement, but it is still somewhat controversial. Some feel that their prolonged use may break through important antibacterial and antiviral immunologic defenses. The therapeutic problem is further increased when the etiology is obscure. This is particularly so if one is confronted with such a symptom-complex, with or without bulbar involvement, during the poliomyelitis season, when the latter cannot be definitely ruled out\p=m-\even in the presence of an acellular spinal fluid. I have recently encountered two patients with a diphtheritic or pseudodiphtheritic polyneuritis in whom the hormones were employed, primarily because of their progressively deteriorating states. Since I have been unable to find any pertinent information or review in the literature concerning this ther¬ apy as specifically employed in diphtheritic polyneuritis, this experience is now set forth. It is hoped that this report may serve as a reference to those who may subsequently be confronted with these considerations. The presentation of a negative response in the one proved patient needs no apology; it merely demonstrates the need for the earlier institution of hormonal treatment, if such therapy proves to be fruitful in the hands of others and is decided upon. The other pa¬ tient, who had ingested apiol and in whom throat cultures were negative, owing possibly to the combination of the long time-interval prior to her seeking medical help and the intervening penicillin therapy, would have been deprived of the salutory effects of corti¬ sone were it not for the fortuitous appearance of a severe penicillin or serum reaction neces¬ sitating its use. A brief review of the perti¬ nent diagnostics and current literature relating to this problem is included in the Comment. REPORT OF CASESCase 1.-A 38-year-old white caretaker was first admitted to the hospital on the ENT service on March 7, 1954. He complained of a severe sore throat of four days' duration and painful swallow¬ ing. Examination revealed an extensive grayish membranous exúdate over the posterior pharynx, tonsillar areas, and soft palate, with lymphadenopathy. The second of two throat cultures was high¬ ly suggestive of diphtheria, and he was transferred to a local contagious disease hospital. He had received penicillin prior to transfer.At the other hospital three nose and throat cul¬ tures were reported as negative for diphtheria and hemolytic Streptococcus. His temperature (106 F) rapidly became normal. The senior physician there did not feel that the patient had a clinical picture of diphtheria, and no antitoxin was administered. He was placed on a course of oxytetracycline (Terramycin) for five days. After 12 days, he was discharged with the diagnosis of acute pharyngitis....