Gulamhussein Mohamed Amirali, Li Yueyang, Guha Abhijit
Department of Orthopaedics, Worcestershire Acute NHS Trust UK, B98 7UB, Redditch, UK.
Department of Orthopaedics, Mid Essex Hospitals NHS Trust UK, Broomfield, Chelmsford, CM1 7ET, UK.
J Orthop Case Rep. 2016 Sep-Oct;6(4):100-102. doi: 10.13107/jocr.2250-0685.592.
Tetanus is a severe and potentially fatal infection caused by the bacterium Clostridium tetani. Of all the cases described in literature, generalized tetanus is by far the most common presentation, but it may also present as neonatal tetanus, cephalic tetanus, and localized tetanus, the latter two being much rarer. In this case report, we present the rare form of this disease, i.e., localized tetanus in an adult male with a history of minimal trauma as well as a late, unusual mode of presentation.
A 35-year-old Caucasian male presented with an acutely painful, swollen right thumb associated with a small superficial collection on the dorsal aspect of the base of the thumb. A formal wound exploration and washout were carried out in theater, however, at the time of tourniquet inflation, the right hand went into a carpopedal spasm and remained in that position until an infusion of a muscle relaxant was given. The findings were consistent with a case of localized tetanus. The patient was treated with human immunoglobulin and tetanus toxoid and safely discharged home 48 h later without any complications.
This case report emphasizes the importance of the recognition of a rare form of this fatal infectious disease, which may present with prodromal symptoms before the generalized form shows its clinical effects. Moreover, the astute clinician should be aware of the variable presentations of this infectious disease, with early identification greatly reducing the associated risks of morbidity and mortality.
破伤风是由破伤风梭菌引起的一种严重且可能致命的感染。在文献中描述的所有病例中，全身性破伤风是迄今为止最常见的表现形式，但也可能表现为新生儿破伤风、头部破伤风和局限性破伤风，后两种情况更为罕见。在本病例报告中，我们呈现了这种疾病的罕见形式，即一名成年男性的局限性破伤风，该患者有轻微创伤史且呈现出较晚且不寻常的发病方式。
一名35岁的白种男性因右拇指急性疼痛、肿胀就诊，拇指基部背侧有一个小的浅表积液。在手术室进行了正式的伤口探查和冲洗，然而，在使用止血带时，右手出现了手足痉挛，并一直保持该姿势，直到注射了肌肉松弛剂。检查结果与局限性破伤风病例相符。患者接受了人免疫球蛋白和破伤风类毒素治疗，48小时后安全出院，无任何并发症。
本病例报告强调了认识这种致命传染病罕见形式的重要性，这种形式可能在全身性症状出现临床效应之前就出现前驱症状。此外，敏锐的临床医生应意识到这种传染病的多种表现形式，早期识别可大大降低相关的发病和死亡风险。
