Recognizing a Forgotten Disease: A Case Report of Tetanus in an Unvaccinated Adolescent

Tetanus is a rare but potentially life-threatening vaccine-preventable disease in the United States. Because tetanus is now rarely encountered in the United States, diagnosis may be delayed despite classic clinical findings. We report the case of an unvaccinated sixteen-year-old Amish male who presented with progressive trismus and cervical rigidity thirteen days after tympanoplasty with mastoidectomy and incus debridement. Initial symptoms were attributed to a postoperative infectious process and treated with oral antibiotics. Progressive jaw stiffness and neck rigidity prompted emergency evaluation. Physical examination demonstrated severe trismus with approximately 1 cm maximal mouth opening and marked cervical muscle rigidity. Laboratory studies and CT (computerized tomography) imaging were unrevealing. A presumptive clinical diagnosis of tetanus was made based on characteristic findings and complete absence of prior immunization. Treatment with tetanus immune globulin, metronidazole, benzodiazepines, supportive care, and active immunization resulted in complete recovery. This case highlights the continued importance of vaccination history, recognition of classic clinical manifestations, and maintenance of diagnostic vigilance for rare vaccine-preventable diseases.