Generalized Tetanus Initially Presenting with Dysmasesis

A 58-year-old male farmer, with no significant history of any chronic morbidity, was admitted via the Emergency Department of SMHS Hospital, Srinagar, with a history of an injury to the hand 20 days earlier followed by a three-day history of dysmasesis (difficulty chewing), progressing to trismus and generalized stiffness interfering with his daily activities. The patient was clinically managed as tetanus on grounds of high clinical suspicion. The patient was treated for a week and discharged without any sequelae to follow-up in the Neurology Outpatient Department of the SMHS Hospital and is currently doing well. After a week of successful management, we received the blood and wound culture reports of the patient that had been sent at the time of his admission to the hospital, which overwhelmingly tested positive for Clostridium tetani. Tetanus is a disease to be suspected post-trauma in patients, especially in developing countries like India. Despite active and passive immunization, it continues to be a significant public health problem in developing countries and should be readily suspected and treated. Although prevention is important for tetanus, the outcomes can be improved by early clinical diagnosis and treatment.