title: Atypical tetanus in a completely immunized 14-year-old boy.
abstract: We report the uncommon clinical course of tetanus in a completely immunized 14-year-old boy. His initial symptoms, which included a flaccid paralysis, supported a diagnosis of botulism. Preliminary mouse-test results with combined botulinum antitoxins A, B, and E, obtained from tetanus-immunized horses, backed this diagnosis. The change in his clinical course from paralysis to rigor and the negative, more specific, botulinum mouse test with isolated botulinum antitoxins A, B, and E, obtained from nonvaccinated rabbits, disproved the diagnosis of botulism. Tetanus was suspected despite complete vaccination. The final results of a positive mouse test performed with isolated tetanus antitoxin confirmed the diagnosis. Adequate treatment was begun, and the boy recovered completely.
authors.affiliation: Children's Hospital, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany. kkonig@mercy.com.au
authors.forename: Kai
authors.initials: K
authors.lastname: König
authors.forename: Hannelore
authors.initials: H
authors.lastname: Ringe
authors.forename: Brigitte G
authors.initials: BG
authors.lastname: Dorner
authors.forename: Alexander
authors.initials: A
authors.lastname: Diers
authors.forename: Birgit
authors.initials: B
authors.lastname: Uhlenberg
authors.forename: Dominik
authors.initials: D
authors.lastname: Müller
authors.forename: Verena
authors.initials: V
authors.lastname: Varnholt
authors.forename: Gerhard
authors.initials: G
authors.lastname: Gaedicke
mesh_terms: D000293:Adolescent; D000818:Animals; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D051379:Mice; D009422:Nervous System Diseases / Q000097:blood / Q000175:diagnosis / Q000276:immunology; D013742:Tetanus / Q000097:blood* / Q000175:diagnosis* / Q000276:immunology; D013743:Tetanus Antitoxin / Q000276:immunology; D014611:Vaccination
chemical_list: D013743:Tetanus Antitoxin