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Return of the old guard: a case of tetanus in an unvaccinated patient
  1. Uzochukwu Ibe1,
  2. Sameerah Rehmani1,
  3. Nasheena Jiwa1 and
  4. Arjet Gega2
  1. 1 Internal Medicine, St. Mary’s Hospital, Waterbury, Connecticut, USA
  2. 2 Infectious Disease, St. Mary’s Hospital, Waterbury, Connecticut, USA
  1. Correspondence to Dr Nasheena Jiwa, sheena99{at}


A 78-year-old woman with no known medical history presented with severe neck pain that began 4 days prior to admission located in the paraspinal cervical region radiating to the shoulders, legs and back. She had associated stiffness of her neck and progression of pain to her jaw and throat with progression to generalised body spasms with lower extremity stiffness and weakness that limited her ability to walk. She quickly developed dysphagia and odynophagia with subsequent generalised spasms and profound hypoxic respiratory failure requiring nasotracheal intubation. The presumptive diagnosis of tetanus was made and she was given tetanus toxoid immune globulin and Tdap vaccine. She was managed in the intensive care unit and after a week of admission, required a tracheostomy and gastrostomy tube placement. She required a prolonged hospitalisation stay of 21 days before being transferred to a long-term vent facility.

  • vaccination/immunisation
  • adult intensive care
  • public health
  • mechanical ventilation
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  • Contributors UI: primary case write-up, involved with patient care. SR: helped with case write-up, involved with patient care. NJ: revised manuscript. AG: infectious disease consultant, involved with patient care.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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