抄録
Tetanus is a disease caused by a toxin produced by Clostridium tetani that presents with muscular spasm and autonomic nervous system disturbance. Thanks to the initiation of regular vaccination since 1968, tetanus has become rare in Japan. Nevertheless, tetanus remains a “Do not miss” diagnosis that requires early diagnosis due to its high fatality rate. Japanese individuals born before 1968 did not receive public vaccinations for tetanus and are at risk for developing tetanus. We report a case of a 62-year-old woman with tetanus that was initially diagnosed with cervical spinal cord injury due to jaw contusion. Despite the patient presenting with a typical combination of tetanus, namely, trismus and muscular spasm, she was diagnosed with cervical spinal cord injury until 4 days after hospital admission because she had had a jaw contusion that served as a “red herring.” Given that tetanus toxoid and anti-tetanus globulin can prevent the development of tetanus even after trauma, our report underscores the importance of tetanus as a differential diagnosis of spasticity in all situations and the importance of availability bias, zebra retreat, authority bias, and diagnostic momentum in diagnostic error.
