A case of tetanus with trismus and unilateral facial spasm

Tetanus often leads to death if early diagnosis and early treatment are not performed. We reporta case of tetanus with trismus and unilateral facial spasm. The patient was a 81-year-old man whowas referred to our hospital because of difficulty in opening his mouth and left eye. Clinical examinationsrevealed severe trismus, unilateral facial spasms, and stiffness of the masseter muscle. However, there wasno symptom of TMJ disease or maxillofacial phlegmon. An injury wound 13cm in length was seen on theright forearm. Blood examinations showed a marked increases in serum creatine phosphokinase activityand leukocytes. These findings were suspected to be caused by tetanus.The patient was admitted to the emergency room of our hospital. A tracheotomy was performed becauseof aspiration pneumonia due to dysphagia and dyspnea. A daily intravenous in fusion of PIPC 4 g was administeredfor 11 days from admission, and 4500 units of antitetanus human immunoglobin was given intravenouslyover the course of 4 days. Oral dantrolen sodium was administered in a dose of 150mg perday. He was discharged after 32 days. There were no functional sequelae.It is important to consider the possibility of tetanus when we treat patients who have difficulty inmouth opening.