[Therapeutic problems in tetanus--presented via a case report]

This is the case presentation of a forty-year old female patient, who had incurred a tetanus infection as a result of intravenous drug abuse. Clostridium tetani could be detected repeatedly in abscesses caused by injections. The patient had to be put on continuous relaxation, sedation and artificial respiration for 42 days. Besides the usual intensive care regimen, a high-dose antitoxin therapy was initiated. The areas of abscesses had to be eradicated surgically several times. With the exception of a thrombus of the vena cava superior (without haemodynamic consequences) and a pneumonia, the further course was without any other serious complications. After seven months of hospitalisation the patient could be dismissed at "restitutio ad integrum". The known immunosuppressive effect of a high dosed tetanus antitoxin therapy could be confirmed by the patient's antitoxin titre course. Repeated active immunisation attempts to produce a sufficient endogenous antitoxin titre failed. The existing therapeutic uncertainties regarding the dosage of the tetanus antitoxin therapy, the titre control and the proper antibiotic treatment are described.