A Case of Generalized Tetanus with an Initial Complaint of Dysphagia

Abstract

Tetanus is generally diagnosed on the basis of presenting typical symptoms and a trauma incident. It often begins with mild spasms in the jaw muscles, or so called lockjaw. However, if the initial symptoms are not typical, accurate diagnosis is rather difficult. We observed generalized tetanus of a 76-year-old female who complained of progressive dysphagia without an obvious history of trauma. During the initial visit to our hospital, there was no definite evidence of cervical pain nor dysphagia. Eventually dysphagia and neck pain as well as stiffness gradually appeared and worsened. When she was no longer able to eat, she was admitted to our hospital. Videofluoroscopic findings revealed residue in both pyriform sinuses due to reduced pharyngeal contraction. The day after she was admitted, she had whole body convulsions for ten minutes. At this point, she was clinically diagnosed with tetanus. Immunoglobulin and an antibiotic were immediately administrated. Ten days later, her criti-cal symptoms including severe dysphagia gradually improved. The experience of our rare case indicate that tetanus should be included in the differential diagnoses for progressive dysphagia even if there was no definite history of injury.