Abstract
A case of severe tetanus with acute renal failure (ARF) caused by rhabdomyolysis is presented. A 47-year-old man was admitted to our hospital because of mild muscle rigidity and trismus. When disturbance in consciousness, opisthotonos and marked sympathetic overactivity occurred on the 2nd hospital day, he was transferred to the ICU. He was diagnosed as severe tetanus following an 8 day incubation period and ARF, which was associated with high serum creatine phosphokinase level and hypermyoglobinemia. He was treated with anti-tetanus therapies (penicilline G, dantrolene, γ-globulin and toxoid), anti-autonomic crisis therapies (either dopamine or Ca2+ blocker) and continuous hemodiafiltration (CHDF) for ARF. The CHDF support was needed for 22 days, until renal function was recovered. However, myoglobin levels in blood and urine were persistently high for more than 38 days. In the case of severe tetanus, intensive support for ARF must be considered in addition to anti-tetanus therapies.
