title: An unusual case of chronic relapsing tetanus associated with mandibular osteomyelitis.
abstract: A 55-year-old man underwent radiation therapy due to malignant lymphoma of the neck. Eight years after the therapy he developed tetanus. It appears that the radiation therapy resulted in mandibular necrosis, and that this lesion may have been the infectious focus of tetanus. Treatment with penicillin G was very effective in the acute stage, and chronic administration of metronidazole prevented relapse of the disease. However in spite of injections of tetanus toxoid, symptoms of tetanus returned when the administration of metronidazole was discontinued because the infectious focus could not be completely removed. This is the first report of chronic relapsing tetanus associated with radiation-induced mandibular osteomyelitis, and demonstrates that tetanus can occur due to mandibular focus but the chronic administration of metronidazole can prevent relapse.
authors: Department of Neurology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki.
authors: Yasuhito
authors: Y
authors: Wakasaya
authors: Mitsunori
authors: M
authors: Watanabe
authors: Masahiko
authors: M
authors: Tomiyama
authors: Chieko
authors: C
authors: Suzuki
authors: Mandy
authors: M
authors: Jackson
authors: Masahiro
authors: M
authors: Fujimuro
authors: Tamaki
authors: T
authors: Kimura
authors: Yusuke
authors: Y
authors: Seino
authors: Takeshi
authors: T
authors: Kawarabayashi
authors: Yukiko
authors: Y
authors: Yamamoto-Watanabe
authors: Etsuro
authors: E
authors: Matsubara
authors: Ikumi
authors: I
authors: Shirahama
authors: Ayumi
authors: A
authors: Takamura
authors: Naoko
authors: N
authors: Nakahata
authors: Mikio
authors: M
authors: Shoji
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D005710:Gallium Radioisotopes; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D016393:Lymphoma, B-Cell / Q000532:radiotherapy; D008297:Male; D008336:Mandibular Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology; D011832:Radiation Injuries / Q000150:complications; D011877:Radionuclide Imaging; D012008:Recurrence; D013742:Tetanus / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents; D005710:Gallium Radioisotopes; D008795:Metronidazole