Return of the old guard: a case of tetanus in an unvaccinated patient

Abstract

A 78-year-old woman with no known medical history presented with severe neck pain that began 4 days prior to admission located in the paraspinal cervical region radiating to the shoulders, legs and back. She had associated stiffness of her neck and progression of pain to her jaw and throat with progression to generalised body spasms with lower extremity stiffness and weakness that limited her ability to walk. She quickly developed dysphagia and odynophagia with subsequent generalised spasms and profound hypoxic respiratory failure requiring nasotracheal intubation. The presumptive diagnosis of tetanus was made and she was given tetanus toxoid immune globulin and Tdap vaccine. She was managed in the intensive care unit and after a week of admission, required a tracheostomy and gastrostomy tube placement. She required a prolonged hospitalisation stay of 21 days before being transferred to a long-term vent facility.

NARRATIVE REVIEW A quick and comprehensive guide to differential diagnosis of neck and back pain: a narrative review

“…32 Poliomyelitis, tetanus, and rabies can also cause back pain and should be considered. 33,34 Acute flaccid myelitis causes fever, neck and back pain with flaccid motor paralysis of various severities, with minimal sensory symptoms, cranial nerve involvement is possible. 35 Tumor Benign tumors of the spine, such as osteoid osteoma or osteoblastoma, will cause back pain that may gradually worsen over time.…”