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Necrotic patch visible as white membrane on left tonsil and a grey patch on the inner pillar of right tonsil in a 7 year boy suffering from DIPHTHERIA. The swelling over left angle of mandible and near right tragus suggest beginning of lymphnode enlargement which can grow large enough to be called 'bull neck'.Membrane may extend down to glottis causing stridor and respiratory obstruction requiring tracheostomy. Exotoxins reach myocardium and invariably cause myocarditis simultaneuosly. Cardiac markers are elevated. This child was not immunised with diphtheria (DPT) vaccine. The serious symptoms like respiratory obstruction and stridor are not seen in this child perhaps due to partial immunity from previous asymptomatic infections.Neurological complications like muscle paralysis, nasal voice or post infectious polyneuropathy (GBS- Gullian Barry syndrome) can occur after 2 weeks to 6 months later.Therefore, not giving a vaccine leads to complications that are life treatening (tracheal obstruction, myocarditis), require expensive treatment like ventilator and/or immunoglobulins.Other causes of white membrane in oral cavity are infectious mononucleosis, streptococci, candida, submucus fibrosis and lichen planus (due to tobacco chewing), poor oral toilet esp with tonsilar cleft.
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