An old woman with pressure ulcer, rigidity, and opisthotonus: never forget tetanus

In view of the characteristic findings on neurological examination and history of infected skin ulcer we diagnosed tetanus, and her son confirmed that she had not received a tetanus vaccine booster for 30 years. We gave a dose of intramuscular tetanus and diphtheria toxoid, intramuscular human tetan...

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Bibliographic Details
Published in:The Lancet (British edition) 2014-12, Vol.384 (9961), p.2266-2266
Main Authors: Verde, Federico, MD, Riboldi, Giulietta, MD, Zappa, Carlo, MD, Ferretti, Marco, MD, Silani, Vincenzo, Prof, Mari, Daniela, Prof, Priori, Alberto, Prof
Format: Article
Language:English
Subjects:
Aged
Alzheimer Disease - complications
Diabetes Mellitus, Type 2 - complications
Dystonia - microbiology
Female
Humans
Immobilization - adverse effects
Internal Medicine
Medical diagnosis
Muscle Rigidity - microbiology
Pressure Ulcer - complications
Pressure Ulcer - microbiology
Pressure ulcers
Rigidity
Tetanus
Tetanus - diagnosis
Trismus - microbiology
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Summary:In view of the characteristic findings on neurological examination and history of infected skin ulcer we diagnosed tetanus, and her son confirmed that she had not received a tetanus vaccine booster for 30 years. We gave a dose of intramuscular tetanus and diphtheria toxoid, intramuscular human tetanus immune globulin 500 U, intravenous metronidazole 500 mg four times daily, and clonazepam 0·7 mg three times daily via nasogastric tube, and she had a repeat surgical debridement of the sacral ulcer.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(14)61832-8