A Case of Cephalic Tetanus in an Elderly Patient with Trismus

Abstract

We report a case of a 77-year-old woman who presented to the Emergency Room with a three-day history of oral lesions and jaw tightness. Her physical examination was remarkable for the presence of trismus and white ulcers on the visible portion of the tongue. CT head and neck was unremarkable, and she was discharged with empiric treatment for oral candidiasis. She returned two days later with worsening symptoms and subsequently developed tonic-clonic seizures. MRI of the brain and temporomandibular joints were noncontributory. Psychiatry was consulted, and the patient was prescribed olanzapine and mirtazapine for suspected depression with somatization symptoms. She continued to deteriorate despite therapy and developed right lid ptosis and ophthalmoparesis, which led to a presumptive diagnosis of cephalic tetanus. On the 14th day of illness, tetanus immune globulin, metronidazole, and tetanus toxoid vaccine were administered. Despite treatment, the patient died after 24 days of hospitalization. This case illustrates the importance of early recognition of tetanus since successful treatment depends on timely administration of immune globulin.

Unusual generalized tetanus evolving from odontogenic infection: A case report and review of recent literature

“…To the best of our knowledge, only six cases of tetanus associated with odontogenic infection have been reported in the last decade. In Table 1 , several cases of the odontogenic origin of tetanus caused by dental procedures, such as tooth extraction, root canal therapy, or injection of an anesthetic, are presented [ 7 , 8 , 9 ]. Moreover, other cases have also reported gross caries, periodontal abscess, or intraoral soft tissue trauma as presumed origin [ 6 ].…”

“…In the absence of these factors, many physicians often do not consider tetanus as the differential diagnosis. To date, only a few studies have discussed the odontogenic origin of tetanus, with the presumed origin being a result of one of the following: tooth extraction, root canal therapy, injection of anesthetic, gross caries, periodontal abscess or intraoral soft tissue trauma [ 6 , 7 , 8 , 9 , 10 , 11 ]. In the present case report, a case of generalized tetanus of presumed odontogenic origin is presented.…”

An Unusual Case of Evolving Localized Tetanus Despite Prior Immunization and Protective Antibody Titer

“…The differentials that can be mistaken for tetanus are meningitis, drug-induced dystonias, trismus due to dental infections, seizure, hypocalcemia, rabies, strychnine poisoning, stroke, malignant neuroleptic syndrome, and stiff person syndrome [7,8]. He did not have altered mentation, meningeal signs, or fever that rules out meningitis.…”

Caprylate/chromatography process to produce highly purified tetanus immune globulin from human plasma

“…This fact along with the decreased immune response to vaccinations in the aged population are likely contributors to the greater lethality of tetanus infections in people over the age of 65 years. [4][5][6][7] In the United States, the number of deaths due to tetanus has been declining since 1900 and the nationwide incidence has been declining since cases were first systematically recorded in the 1940s.…”