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Published on: February 29, 2020

A case of otogenic tetanus

Mohammad Adeel1, Shaheryar Ahmed Rajput, Muhammad Sohail Awan

  • 1Otorhilaryngology Head & Neck Surgery Department, Aga Khan University Hospital, Karachi, Sindh, Pakistan. doc.adeel.khan@gmail.com

BMJ Case Reports
|July 5, 2012
PubMed

Insights

A 12-year-old girl with chronic ear infections developed trismus and hand stiffness. Prompt diagnosis and treatment of otogenic tetanus led to symptom improvement, highlighting a rare but serious complication of otitis media.

Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Neurology

Background:

  • Otitis media is a common childhood infection, but can lead to serious complications.
  • Tetanus, caused by Clostridium tetani, is a serious bacterial infection that affects the nervous system.

Observation:

  • A 12-year-old girl presented with a 3-month history of bilateral otorrhea and a 1-week history of trismus and palatal paralysis.
  • Initial management with antibiotics for presumed otitis media was ineffective.
  • Clinical suspicion of otogenic tetanus arose due to trismus and hand muscle stiffness.

Findings:

  • Computed tomography (CT) scan of the head and neck revealed decreased pneumatization of mastoid cells but no intracranial complications.
  • Treatment with tetanus toxoid and immunoglobulins resulted in gradual symptom improvement.
  • Ear discharge culture confirmed the presence of Clostridium tetani.

Implications:

  • This case highlights the importance of considering rare complications like otogenic tetanus in refractory otitis media cases.
  • Early recognition and appropriate management, including tetanus prophylaxis, are crucial for favorable outcomes.
  • Otogenic tetanus is a critical diagnosis that requires prompt intervention beyond standard antibiotic therapy for otitis media.

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