title: Case report of tetanus in an immunized, healthy adult and no point of entry.
abstract: We report the case of a 58-year-old man born in the United States with a history of complete childhood immunizations who presented to the Emergency Department with trismus. Past medical history was significant only for Elephantiasis. After an exhaustive workup the patient was found to have Tetanus, with no identifiable portal of entry. The patient was successfully treated for Tetanus with complete recovery. Tetanus is caused by the organism Clostridium Tetani, which usually requires an open lesion to cause infection. Our patient was unique in that he was previously immunized with no obvious lesion. Tetanus should be suspected and treated empirically in any patient presenting with typical signs and symptoms even without an apparent entry site.
authors.affiliation: Department of Emergency Medicine, State University of New York-Downstate Medical Center, Brooklyn, New York 11203, USA.
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Hahn
authors.forename: Mert
authors.initials: M
authors.lastname: Erogul
authors.forename: Richard
authors.initials: R
authors.lastname: Sinert
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D004632:Emergency Medical Services; D006801:Humans; D007114:Immunization; D007262:Infusions, Intravenous; D008140:Lorazepam / Q000627:therapeutic use; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D013742:Tetanus / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D013743:Tetanus Antitoxin / Q000627:therapeutic use; D016896:Treatment Outcome; D014313:Trismus / Q000209:etiology
chemical_list: D000890:Anti-Infective Agents; D000927:Anticonvulsants; D013743:Tetanus Antitoxin; D008795:Metronidazole; D008140:Lorazepam