Case report: Plasma exchange treatment in a patient with severe tetanus

Tetanus, a severe illness caused by Clostridium tetani, entails symptoms such as muscle spasms and tissue necrosis due to the production of tetanus toxin and hemolysin, posing a grave risk to life. Plasma exchange is infrequently used in tetanus treatment due to limited reported cases, guidelines, the relative rarity of tetanus cases, the high cost and technical complexity of the treatment, and the need to carefully balance risks and benefits. In this case study, a 57-year-old male with a recent foot injury presented with classical tetanus symptoms, including lockjaw, neck stiffness, and lower limb hypertonicity. Upon admission, his condition deteriorated rapidly, leading to cardiac arrest. Following successful resuscitation, he was admitted to the ICU. The patient underwent plasma exchange due to persistent symptoms, ultimately showing partial functional recovery and being discharged for rehabilitation. Clinical evidence supports plasma exchange's ability to eliminate macromolecules, autoantibodies, immune complexes, cytokines, and inflammatory mediators from the body. Despite its uncommon use in tetanus infections, our patient's treatment with plasma exchange facilitated toxin removal and alleviated persistent symptoms. This case contributes to expanding our understanding and offers a novel therapeutic option for severe tetanus cases.