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Rationale: Tetanus is usually caused by wound infection with Clostridium tetani after acute injuries. Skin cancer wound is a rarely reported cause of tetani infection. It is difficult to be diagnosed and mistaken for other brain lesions., Patient Concerns: A 49-year-old man presenting with the only symptom of repeated convulsions was admitted to our department. He had an ulcerated skin cancer on the right buttock that had been excised in another hospital 1 month before admission, leaving the wound unhealed. He was suspected of having a metastatic brain tumor early, but exhibited a negative cranial CT-scan., Diagnosis: Tetanus was diagnosed when he was observed to have sudden convulsions after sensory stimulation such as noise, light, or touch., Interventions: Despite administration of a high dose of diazepam and phenobarbitone, continuous generalized rigidity with laryngospasm still occurred. Instead, when propofol was intravenously infused, the spastic convulsion completely stopped. Tracheotomy and mechanical ventilation were performed., Outcomes: The patient gradually recovered in 2 weeks., Lessons: Tetanus is rarely infected through the wound of an ulcerated skin cancer. Early diagnosis can only be based on accurate assessment of clinical manifestations, and propofol infusion appears to be more effective in anti-convulsion management for patients with tetanus. Routine vaccination to prevent tetanus in patients with ulcerated skin cancer should be considered in the future clinical work.

Background: This review covers the pathogenesis and treatment of the disease along with the reexamination of the current recommendations for prophylaxis against tetanus in the United States. Although tetanus is still a major problem worldwide, the incidence in North America has become almost negligible because of the highly effective primary immunization program. Recently, there have been no deaths reported attributable to tetanus in the United States in trauma patients who had received the primary childhood immunization. However, tetanus immunization and prophylaxis in the acute injury setting is frequently misused and misunderstood., Methods: A review of the literature regarding tetanus., Results: After review, the authors recommend tetanus toxoid in adults only if it has been more than 10 years since their last immunization. There is no urgency for the administration of tetanus toxoid in the acute setting, as it provides protection against the next injury and not the current injury. Tetanus-diphtheria toxoid is not required unless there are plans for the injured patient to travel to diphtheria-prone countries in the future, as the incidence of diphtheria is negligible in the United States., Conclusion: The review of reported cases of tetanus demonstrates that it is not possible to clinically determine which wounds are tetanus prone, as tetanus can occur after minor, seemingly innocuous injuries, yet is rare after severely contaminated wounds. Tetanus immunoglobulin should be reserved for patients with wounds who had never received primary immunization against tetanus.

We report a case of tetanus associated with the syndrome of sympathetic overactivity. BP changes were associated with changes in systemic vascular resistance index (SVRI). Cardiac index (CI) varied independently from changes in SVRI and was correlated with the stroke volume. Oxygen consumption during the hypotensive periods was normal. Among several pharmacologic agents, only curare was effective in decreasing the severity and number of the hypertensive episodes. Physical stimulation of the patient rapidly reversed the hypotension. The potential mechanisms involved in producing these cardiovascular abnormalities are discussed.

This case of successfully managed clinical tetanus following osteomyelitis of a minimally fractured zygoma serves to remind us to consider the possibility of this diagnosis even in an apparently uncomplicated facial wound. The prodromal and clinical signs of tetanus in this case are classical. Early recognition of the disease and appropriate supportive measures lead to an anticipated outcome.

A case of tetanus in an unimmunized burned patient is presented. This foreign national sustained a 32% total body surface area burn, received inadequate prophylaxis initially, and subsequently developed tetanus 11 days postburn.

An uncommon type of homicide resulted from complications of an ordinarily nonfatal injury after a 59-year-old obese, hypertensive, diabetic man was struck in the face with a two-by-four, sustaining a grossly contaminated laceration. It was cleaned and sutured primarily, and a tetanus booster was given. On the fourth hospital day there was evidence of anerobic wound cellulitis, including Clostridium tetani. The wound was surgically debrided, but 2 days later the patient developed local tetanus. Only then was it discovered that he had never been immunized against tetanus. He did not develop systemic tetanus, but 2 days later he died with bronchopneumonia and sepsis. The assailant was indicted for involuntary manslaughter, but after a contentious trial he pleaded "no contest" to a reduced charge. The decedent was a vulnerable host, his contaminated facial laceration initiating an unbroken course of events that led to his death.