Abstract
This paper reports a case of severe tetanus complicated with nonclostridial gas gangrene, that originated from a contused wound to the right lower leg caused by the great tsunami of The Great East Japan Earthquake, in which landiolol was effective to treat severe circulatory changes. A 50-year-old female patient, who was diagnosed with diabetes by a local doctor, but remained untreated, was injured in her right lower leg during the tsunami of The Great East Japan Earthquake on March 11, 2011. Subsequently, gas gangrene was suspected due to the presence of snow ball crepitation and signs of gas pooling on X-ray, and the patient was referred to the author's hospital. From the next day, posterior cervical pain, trismus, and severe circulatory changes were observed, diagnosed as complications of severe tetanus. The wound was debrided, while PIPC/TAZ and tetanus immunoglobulin therapies were performed. Circulatory management continuously using midazolam and vecuronium initially did not show favorable outcomes, and the circulatory system was promptly stabilized by the additional administration of landiolol, a β1 receptor antagonist. This may be regarded as a result of β1 receptor stabilization with landiolol, resolving tetanus-associated autonomic disturbances leading to circulatory changes; however, there have been no studies reporting the use of landiolol for tetanus in Japan, and, therefore, it may be necessary to continuously examine its effects. Further, considering that, to the author's knowledge, tetanus complicated with nonclostridial gas gangrene has not been reported after 1984, this may be quite a rare case.
