[Tetanus, an almost forgotten but serious disease]

Tetanus, an almost forgotten but serious disease Tetanus is the systemic consequence of a local infection with Clostridium tetani, that produces toxin which spreads in the systemic circulation. In developed countries, it is extremely rare. Women born before 1950 are a group at risk due to lower prevalence of immunisation. This report describes a case of tetanus. The patient is a previously healthy 82-year-old woman. She presented to primary care with a complaint of stiffness in the neck and jaw. A physical exam and basic laboratory tests were normal apart from a slightly increased blood pressure. Later the same day she was admitted to the intensive care unit for suspected tetanus. During the night she deteriorated with marked stiffness in her thorax and, as a result of this, severe respiratory distress. After induction of anesthesia she was ventilated and intubated without problem. The treatment for tetanus, an antibody, was given 5 hours later after urgent delivery from the national supply. The patient was successfully weaned from the ventilator after 37 days. During intensive care she had fluctuating stiffness and autonomic instability, both commonly described in patients with tetanus.