Diphtheria with Measles Co-Infection in a Severely Malnourished, Unvaccinated Child: A Case Report from a Resource-Limited Setting.

Background: Diphtheria and measles persist in regions with low vaccination coverage, where co-infection can lead to severe disease, especially in malnourished children. Diphtheria antitoxin shortages and limited diagnostic capacity further complicate timely management in low-resource settings. This report describes clinically evident diphtheria and measles co-infection in an unvaccinated, severely malnourished child. Case Presentation: A 12-year-old unvaccinated girl from rural Somalia presented with a four-week history of high fever, sore throat, dysphagia, nasal regurgitation, cough, and progressive neck swelling. She was severely malnourished. Examination revealed cervical lymphadenopathy, severe pharyngeal inflammation, oral thrush, and later Koplik spots and a generalized rash consistent with measles. Laboratory confirmation for both infections was unavailable, and diphtheria antitoxin was not accessible. She received oxygen, intravenous ampicillin and gentamicin, vitamin A, nasogastric feeding, and nutritional rehabilitation, leading to clinical improvement. At follow-up, she had gained weight, resumed full oral intake, and demonstrated near-complete respiratory recovery. Conclusion: This case highlights the interaction of vaccine-preventable infections and severe malnutrition in a low-resource setting. Early syndromic recognition of diphtheria and integration of nutritional rehabilitation are critical where diagnostic and therapeutic options are limited. Strengthening immunization and improving access to diphtheria antitoxin remain essential.