Acute stanford type B aortic dissection during severe adult tetanus: a case report and mechanistic hypothesis

Severe tetanus causes autonomic dysfunction and generalised muscle spasms, which can produce marked haemodynamic swings that may injure the aortic wall. Aortic dissection complicating tetanus is nevertheless extremely rare, and its clinical course is poorly documented. A 58-year-old man with severe tetanus (Ablett grade IV) developed an acute Stanford type B aortic dissection during recurrent episodes of autonomic instability and generalised muscle spasms. The primary intimal tear lay at the T4–T5 vertebral level, corresponding anatomically to concurrent acute compression fractures of T2–T6. He was treated with mechanical ventilation and thoracic endovascular aortic repair (TEVAR). His only intensive-care complication was ventilator-associated pneumonia, which resolved with treatment. He was discharged in stable condition and at 3 months was free of pain, with good functional status, blood pressure well controlled without antihypertensive medication, and no reintervention; he declined follow-up computed tomography angiography, so aortic remodelling could not be assessed. The association we describe is temporal only and does not establish that tetanus caused the dissection. We offer a speculative “biomechanical stress–neuroendocrine storm” hypothesis to frame this rare complication and to alert clinicians to potentially life-threatening vascular events in severe tetanus.