Clinical tetanus in an 11 year old boy

摘要

An 11 - year old boy presented to the emergency department (ED) 12 days following a puncture wound to his right foot sustained while playing barefoot outdoors. Four days prior to presentation, he experienced pain in his left jaw and teeth, and over the following two days developed chest tightness, and became unable to open his mouth fully, tolerating only pureed food and liquids. He attended his general practitioner (GP), and was commenced on amoxicillin/clavulanic acid for a possible dental infection. Owing to worsening symptoms he represented to his GP at which time clinical tetanus was suspected and he was referred to the ED; no medical history of relevance; the child was unvaccinated. On examination, the patient was noted to be well in no acute distress, vital signs within normal range for age. Of significance, there was marked spasm of the patient's jaw muscles with limited opening demonstrated (Figure 1).