A 63-year-old woman was referred to our hospital because of trismus. Clinical examinations revealed severe trismus and severe stiffness of the masseter and sternocleidmastoid muscles, but there were no symptoms of temporomandibular disorders, maxillofacial tumors, or infectious diseases. Blood examinations showed a marked increase in serum creatine phosphokinase activity. The cerebrospinal fluid was normal. These findings led to the clinical diagnosis of tetanus. The patient was admitted to the hospital immediately and received antibiotics, midazolam, and propofol. However, she refused antitetanic human immunoglobulin to avoid the risk associated with blood products. We exchanged some documents that certified our exemption from responsibility for not using antitetanic immunoglobulin beforethe operation. Tracheal intubation and tracheotomy were performed because of tetanus dorsalis, airway obstruction, and circulatory disturbance. She was discharged on the 86 th hospital day. There were no functional sequelae.
