Lesson of the week: Tetanus in an immunised patient

Do not rule out a diagnosis of tetanus in a patient who has been immunised fully Immunisation with alum absorbed tetanus toxoid is one of the most highly effective preventive measures in medical practice. The estimated failure rate is extremely low. We report a case of severe generalised tetanus in a patient who had been immunised fully. A previously healthy 34 year old construction worker was admitted to hospital after experiencing what was described as an epileptic fit Before the fit, the man had had flu-like symptoms for three days. He denied that he had sustained any trauma before the episode, and he had no history of recurrent infections. Physical examination showed that the patient had a low grade fever (37.6°C) His blood pressure was 120/80 mm Hg and pulse rate was …