Abstract
A case of severe respiratory diphtheria complicated by myocarditis is reported. Diphtheria myocarditis manifested as cardiogenic shock and progressive conduction disturbance. Temporary transvenous ventricular pacing was used to manage this complication successfully. However, this patient died from cardiogenic shock. This case highlights that sporadic cases of diphtheria still occur despite high vaccination rates in Saudi Arabia. Conduction abnormalities in diphtheria myocarditis carry a prognostic marker for the severity of cardiac injury.