Localized Tetanus in an Adult Patient: Case Report.
BACKGROUND
Tetanus is a severe and potentially fatal infection caused by the bacterium Clostridium tetani. Of all the cases described in literature, generalized tetanus is by far the most common presentation, but it may also present as neonatal tetanus, cephalic tetanus, and localized tetanus, the latter two being much rarer. In this case report, we present the rare form of this disease, i.e., localized tetanus in an adult male with a history of minimal trauma as well as a late, unusual mode of presentation.


METHODS
A 35-year-old Caucasian male presented with an acutely painful, swollen right thumb associated with a small superficial collection on the dorsal aspect of the base of the thumb. A formal wound exploration and washout were carried out in theater, however, at the time of tourniquet inflation, the right hand went into a carpopedal spasm and remained in that position until an infusion of a muscle relaxant was given. The findings were consistent with a case of localized tetanus. The patient was treated with human immunoglobulin and tetanus toxoid and safely discharged home 48 h later without any complications.


CONCLUSIONS
This case report emphasizes the importance of the recognition of a rare form of this fatal infectious disease, which may present with prodromal symptoms before the generalized form shows its clinical effects. Moreover, the astute clinician should be aware of the variable presentations of this infectious disease, with early identification greatly reducing the associated risks of morbidity and mortality.
Department of Orthopaedics, Worcestershire Acute NHS Trust UK, B98 7UB, Redditch, UK.
Mohamed Amirali
MA
Gulamhussein
Department of Orthopaedics, Mid Essex Hospitals NHS Trust UK, Broomfield, Chelmsford, CM1 7ET, UK.
Yueyang
Y
Li
Department of Orthopaedics, Worcestershire Acute NHS Trust UK, B98 7UB, Redditch, UK.
Abhijit
A
Guha
Localized tetanus; carpopedal spasm; wound exploration