SHM Converge Scientific Abstract ePoster Gallery-Nail the Diagnosis: Rapid Recognition of Tetanus in the Vaccine Era

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This case describes a 26-year-old man with acute respiratory distress, jaw malocclusion, dysphagia, muscle spasms, hyperreflexia, urinary retention, and episodes of apnea. He had alcohol and cocaine use before presentation, worked in a fence factory with frequent minor wounds, and had only childhood vaccinations from Mexico. Because cocaine intoxication or adulteration was initially suspected, he received naloxone and diazepam without improvement. Tetanus was then recognized clinically, and tetanus immunoglobulin led to rapid symptom improvement.

The report emphasizes that <em>Clostridium tetani</em> usually enters through penetrating wounds, though many patients do not recall a clear injury. The average incubation period is about 8 days. Important risk factors include lack of vaccination, older age, diabetes, and IV drug use. In the United States, tetanus still carries significant mortality, about 11%.

The differential diagnosis includes drug-induced dystonias, stiff-person syndrome, dental infection, neuroleptic malignant syndrome, rabies, cerebral malaria, hypocalcemia, and especially strychnine poisoning, which is the closest mimic. Rapid clinical recognition is crucial because tetanus remains a rare but dangerous disease in the vaccine era.

Treatment includes tetanus immunoglobulin, tetanus vaccination, wound debridement, metronidazole, and supportive care such as benzodiazepines, neuromuscular blockade, magnesium infusion, and adrenergic blockers when needed. Recovery can take months, but this patient improved quickly and was discharged after 3 days with residual weakness that was improving.

The key message is that clinicians must keep tetanus in mind when patients present with muscle rigidity, spasms, or jaw symptoms, especially if vaccination status is uncertain or wounds are present.

Asset Subtitle

Samuel A. Mickel-Hulse

Meta Tag

Author List Jessica L. Guidici, Samuel A. Mickel-Hulse

Category Clinical Vignettes

Concept Tetanus

Concept Rigidity

Concept Muscle Spasm

Concept Trismus

Concept Tetanus Immunoglobulin

Distinguished Non-Finalist

Presenter Organization Internal Medicine/Pediatrics, University of North Carolina Hospitals

Presenting Author Samuel A. Mickel-Hulse

Track Adult

Keywords

tetanus

Clostridium tetani

jaw malocclusion

muscle spasms

dysphagia

acute respiratory distress

tetanus immunoglobulin

wound exposure

vaccination status

strychnine poisoning

Tetanus

Rigidity

Muscle Spasm

Trismus

Tetanus Immunoglobulin