Severe autonomic dysfunction in an 11-year-old girl with generalised tetanus

Tetanus can occur even after minor injuries, and proper immunisation status must be ascertained and documented in every surgical patient. Failure to do so can have dramatic consequences. An 11-year-old non-immunised girl was admitted to the intensive care unit with severe generalised tetanus 8 days following an open fracture of the right forearm. Although she was under deep sedation and received high doses of opiates while being paralysed and mechanically ventilated, she developed pronounced cardiovascular instability with tachycardia and periods of rapid changes between arterial hyper- and hypotension secondary to severe autonomic dysfunction. Her cardiovascular status only began to stabilise after 14 days under concomitant treatment with clonidine, magnesium sulphate and labetalol.