Fatal Tetanus After Prophylaxis With Human Tetanus Immune Globulin

To the Editor:— Prophylaxis of tetanus is best accomplished by active immunization with tetanus toxoid. In the unimmunized, prophylaxis can be passively accomplished with human tetanus immune globulin. The recommended dose of human tetanus immune globulin is 250 units given intramuscularly at the time of the injury.¹To our knowledge, there have been no reports of tetanus after prompt administration of human tetanus immune globulin, in the recommended dosage. We report a case of tetanus following prompt administration of 250 units of human tetanus immune globulin. Report of a Case:— A 45-year-old white man dropped a railroad tie on his left hand. That day, the patient's physician sutured the wound and gave him 250 units of tetanus immune globulin intramuscularly. There was no history of active immunization for tetanus, prior injury, or past military service. Three days later gangrene developed in the fourth finger of the left hand and