Cephalic Tetanus: A Rare Case Report

Introduction Tetanus is a preventable infectious disease with vaccination. Cephalic tetanus is the rarest form in which local tetanus can involve the cranial nerves. Case Herein, we report a case of cephalic tetanus in a 16-month-old girl who had never been vaccinated. The patient, who had a complaint of a wound on the cheek mucosa for 2 weeks, was seen playing with the soil in the garden 1 week ago and was found to have abundant soil removed by her mother. The patient was diagnosed as cephalic tetanus according to her complaints and clinical findings. Discussion We believe that, this is the first case reported in the literature of cephalic tetanus in such a young child wherein the disease focus of infection from a wound on the cheek mucosa. The symptom we defined as ‘a child who cries when she smiles’ presented in this case could only be associated with this disease. Conclusion In addition to detailed anamnesis and meticulous physical examination, the clinical symptoms that we have described for the first time in a child with cephalic tetanus should also be considered for early and accurate diagnosis.

CEPHALIC TETANUS A RARE LOCAL TETANUS

Woman, 68 years old came to hospital with chief complain trismus and dysphagia. She was in a good condition with physical examination and standard laboratory test reveal normal value. The neurologist found multiple parese of cranial nerve (V, VII, IX, X, XI). After further examination include electromedic test and head ct scan with contrast the neurologist did not find any abnormality that may explain her symptoms. The patient then consulted to the internist with suspect of local tetanus infection because of focal infection in her dental caries. The patient is then treated with antibiotics, convultion inhibitor agent, also given tetanus immunoglobulin. During the treatment, her symptoms improved. There were no other severe complication. Patient was returning home on the ninth day of hospitalisation and ready for her dentist appointment.Keywords : Trismus, dysphagia, parese, tetanus, tetanus imunoglobulin