title: [Two cases of generalized tetanus presenting with dysphagia as an initial symptom].
abstract: We describe two patients with generalized tetanus, a 60-year-old man and a 76-year-old woman, presenting with dysphagia as an initial symptom of the disease. Eighty percent of patients with generalized tetanus manifest dysphagia on admission to a hospital. However, dysphagia is rare as an initial symptom. Both our patients had dysphagia as their initial symptom, followed by neck stiffness and trismus. We made a diagnosis of generalized tetanus based on these neurological findings in the absence of an apparent episode of trauma. After the administration of tetanus immunoglobulin on admission, they recovered without exhibiting generalized convulsion, autonomic storm, or any other serious complications. The vaccination of tetanus toxoid cannot maintain sufficient antibody titers more than ten years. Therefore, elderly people are considered susceptible to tetanus. We suggest that tetanus should be considered in the differential diagnosis of dysphagia particularly in elderly patients. We also suggest that treatment of tetanus should be initiated immediately, because tetanus still has a high mortality rate at present.
authors.affiliation: Department of Neurology, Brain Research Institute, Niigata University, 1 Asahimachi, Niigata 951-8585, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Kanazawa
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ishiguro
authors.forename: Osamu
authors.initials: O
authors.lastname: Onodera
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Yoshikawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Koide
authors.forename: Aki
authors.initials: A
authors.lastname: Arai
authors.forename: Arika
authors.initials: A
authors.lastname: Hasegawa
authors.forename: Ryouichi
authors.initials: R
authors.lastname: Nakano
authors.forename: Keiko
authors.initials: K
authors.lastname: Tanaka
authors.forename: Masatoyo
authors.initials: M
authors.lastname: Nishizawa
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013742:Tetanus / Q000150:complications*