ABSTRACT

Cutaneous diphtheria is an under-recognised manifestation of an infection which is caused by Corynebacterium diphtheria (C. diphtheriae) and particularly in endemic regions. Usually it presents as a chronic non-healing ulcer and is frequently polymicrobial origin, which may lead to misidentification as contamination. In this article, we have reported four cases of cutaneous diphtheria, including one toxigenic strain with severe clinical progression and three non-toxigenic strains associated with diabetic foot ulcers. Diagnosis of this condition was established through careful Gram stain examination, culture reports, and confirmatory testing using MALDI-TOF or PCR with Elek’s test. Recognising the condition at an early stage is important for appropriate antimicrobial therapy, infection control, and prevention of transmission. In this case series, we have highlighted the continued relevance of cutaneous diphtheria in India, where underreporting remains a concern.