Generalized Tetanus in a Case of an Immunized Patient

Purpose: Tetanus is an infectious disease rarely occurring in developed countries, but its severity, and the possibility of developing multiple complications, some life-threatening, made its recognition and treatment to be a medical emergency. Methods & Materials: The case report was based on the medical information from the database of County Emergency Clinical Hospital Oradea's (CECHO), Bihor region, Romania. Results: The authors present the case of a 31-year-old female, with obesity, hyperinsulinemia, insulin resistance, intramuscular injections performed by unauthorized persons at the patient's home with 3 weeks before, and with a complete immunization antitetanic history, serum antitoxin level of 2.21 IU/mL, who presented to the emergency department of CECHO, in May 2021, for sore throat, trismus, opisthotonos induced by minimal external stimuli. C-reactive protein was slightly increased (35.9 mg/L), computed tomography and magnetic resonance imaging of the head showed no pathological changes. The diagnosis was based on the presence of clinical features.The patient followed specific etiological treatment. Metronidazole and Penicillin G were added as an antibiotic regimen. The patient responded slowly to the human tetanus immunoglobulin (5500 IU), in addition with one dose of tetanus toxoid adsorbed, with decreasing frequency and intensity of opisthotonos. Conclusion: There are only a few reported cases of tetanus in immunized individuals in the medical literature (1). The mechanism of this is unclear. The antigenic variability, or an immune suppression, possibly mediated by leptin in the context of obesity, insulin resistance must be considered (1,2,3). The case emphasizes that the diagnosis of tetanus should not be rejected solely based on the presence of specific antibodies.