[A patient with tetanus without an obvious point of entry]

A 59-years-old man with oesophageal cancer (T3NXMo) presented with trismus, dysarthria and diaphoresis. Later, he developed opisthotonus and generalized spasms. Despite negative blood cultures and sufficiently high anti-tetanus-titres, tetanus was suspected, on clinical grounds. He was intubated and treated with tetanus toxoid, human antitetanus immunoglobulin, benzylpenicillin, propofol, benzodiazepines, vecuronium, and sufentanil, and recovered gradually. Tetanus is caused by Clostridium tetani, a Gram-positive rod capable of remaining present latently in the body for years. Absence of a visible external wound suggests that the oesophageal mucosal cancer lesion could have served as portal of entry or that endogenous reactivation of latent tetanus bacteria had taken place.