A case of tetanus in which Clostridium tetani was isolated from a scab

Abstract

A 69-year-old woman was referred to our department because of trismus. Physical examination showed a normal temporomandibular disorder, and she was prescribed a muscle relaxant and analgesic and went home. However, her symptoms became worse, and she was re-examined 2 days later and had severe trismus, stiffness of the masseter muscles, neck pain, and backache. She had a scab from a minor injury on the left knee. Tetanus was diagnosed on the basis of the clinical course and symptoms. The patient was immediately admitted to the intensive care unit. She was given anti-tetanus human immunoglobulin, tetanus toxoid, and antibiotics. The patient recovered without tracheotomy or tracheal intubation. We isolated Clostridium tetani from the scab on her knee, and tetanus was clinically and biologically diagnosed. Isolation of Clostridium tetani is very rare, and to our knowledge this is a rare case in which Clostridium tetani was isolated from a scab. Even if the wound shows signs of healing, tetanic symptoms do not improve, and such wounds should always be débrided for therapeutic purposes.