Acute aspiration and trismus due to tetanus

Tetanus is a worldwide health problem, causing the deaths of approximately 1,000,000 people every year. In Germany, about 15 infections are reported annually. The initial symptoms often develop in the head and neck region. As a result, some patients are referred to the otorhinolaryngologist. We report on a 83 year old female who suffered from recurrent aspiration and trismus. She had acquired a small injury on her lower leg 2 weeks earlier; protective antibody levels did not exist. The neurophysiological examination showed a result typical of tetanus. The patient received tetanus immunglobulin, metronidazole and benzodiazepines. Due to respiratory problems, tracheotomy and ventilation became necessary. Elderly people often lack protective antibody levels against tetanus. If typical symptoms are manifest, tetanus has to be considered as a possibility. A complete history, including recent injuries and past vaccinations, should be compiled.