Severe Respiratory Diphtheria Complicated by Myocarditis-Induced Dilated Cardiomyopathy and Peripheral Neuropathy in a Non-Immunized Two-Year-Old Child from Rural Somalia: A Case Report.

Introduction: Diphtheria remains a serious vaccine-preventable infection, particularly among under-immunized children in fragile and resource-limited settings. In Somalia, gaps in routine immunization, delayed healthcare access, and limited diagnostic and treatment resources may increase the risk of severe toxin-mediated complications. Cardiac and neurological involvement are among the most serious manifestations, and their coexistence in a young child is uncommon. Case Presentation: We report the case of a non-immunized two-year-old boy from rural Somalia who presented with fever, sore throat, progressive dysphagia, respiratory distress, bull-neck swelling, and a firmly adherent grayish-white pharyngeal pseudomembrane. He developed clinical and echocardiographic evidence of diphtheritic myocarditis complicated by toxin-induced dilated cardiomyopathy, followed by progressive symmetrical limb weakness with markedly reduced deep tendon reflexes, consistent with diphtheritic peripheral neuropathy. He was treated with diphtheria antitoxin, intravenous erythromycin, isolation, cardiac monitoring, heart failure therapy, physiotherapy, and nutritional support. His respiratory, cardiac, and neurological status improved progressively, and at one-month follow-up he had no clinical signs of heart failure and was able to walk with minimal support. Conclusion: This case highlights that diphtheria remains a life-threatening but preventable multisystem disease among unvaccinated children in fragile settings. Early clinical recognition, prompt antitoxin administration, antimicrobial therapy, cardiac monitoring, and supportive multidisciplinary care are essential. The report also reinforces the urgent need to strengthen routine childhood immunization in Somalia to prevent severe disease and avoidable complications.