Idris Iqlima, Mafauzy Mohamad Masykurin, Baharuddin Kamarul Aryffin, Alwi Farah, Mohamad Wan Syahmi Wan
Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia.
Hospital Universiti Sains Malaysia, Kelantan, Malaysia.
Turk J Emerg Med. 2022 Sep 30;22(4):226-229. doi: 10.4103/tjem.tjem_68_22. eCollection 2022 Oct-Dec.
Abdominal tetanus is the rarest presentation of localized tetanus in which other muscles are not involved. Proper diagnosis is challenging as it mimics acute abdomen. We describe the challenges in diagnosing this atypical localized tetanus in an adult and a review of case reports. Our patient is a 40-year-old male who presented to the emergency department with generalized abdominal pain for 3 days. His physical examination revealed a guarded abdomen with tenderness in the epigastric region, while systemic examinations were unremarkable. The initial diagnosis was acute abdomen with suspected perforated viscus. Subsequently, he developed arching of the back on day 3 of admission with markedly elevated serum creatine kinase levels. A diagnosis of localized tetanus was made, and an uneventful recovery was achieved after management. Clinicians should be aware of the atypical presentations of abdominal tetanus as it mimics acute abdomen. Early recognition and initiation of treatment significantly reduce morbidity and mortality risks.
腹部破伤风是局限性破伤风最罕见的表现形式，不累及其他肌肉。由于其酷似急腹症，正确诊断具有挑战性。我们描述了诊断一名成年患者这种非典型局限性破伤风时所面临的挑战，并对病例报告进行了回顾。我们的患者是一名40岁男性，因全腹痛3天就诊于急诊科。体格检查发现腹部有压痛，上腹部压痛明显，而全身检查无异常。初步诊断为疑似脏器穿孔的急腹症。随后，他在入院第3天出现背部弓形，血清肌酸激酶水平显著升高。诊断为局限性破伤风，经治疗后康复顺利。临床医生应意识到腹部破伤风的非典型表现，因为它酷似急腹症。早期识别和开始治疗可显著降低发病率和死亡率风险。
