When TAT fails: A case of generalized tetanus and reactive thrombocytosis

Tetanus remains a life‑threatening infection caused by Clostridium tetani neurotoxin. We report a 59‑year‑old male construction worker who developed generalized tetanus 21 days after a rusty metal laceration, despite prior wound debridement and tetanus antitoxin (TAT) administration at a local hospital. He presented with mild trismus but rapidly progressed to generalized spasms, respiratory compromise, and autonomic instability. Early percutaneous dilatational tracheostomy combined with fibreoptic bronchoscopy for pulmonary toilet effectively secured the airway and prevented aspiration pneumonia. During recovery, reactive thrombocytosis (platelets rising from 344 to 649 × 10⁹/L) was observed. The patient was successfully discharged after comprehensive critical care. This case highlights the diagnostic pitfalls of relying on prior passive immunization, the value of early airway intervention, and the need for public health awareness in high‑risk populations.