Case Report A 25-Year-Old Male Presenting with Tetanus Urgent message: Unusual as the diagnosis may be in 2009, patients with symptoms of what is later confirmed to be tetanus may be more likely to present to urgent care than to other practice settings. Curtis G. Kommer, MD, Latha Shankar, MD, and Mario Kapetsonis, MD town Milwaukee six days after sustaining a puncture etanus, a toxin-mediated wound to the right thigh infection of gram-positive while pruning bushes. Ini- bacteria Clostridium tetani, tially, he cleaned the is a rare presentation in the wound with water and 21 st century. Since 2000, peroxide, then dressed it there have been fewer than with a triple-antibiotic 50 cases per year reported in ointment. the United States. 1 At presentation, he However, at-risk patients complained of a three-day such as unimmunized chil- history of fever, chills, and dren, unboostered adults, generalized muscle aches, intravenous drug (particu- culminating in a one-day larly heroin) users, undoc- history of increasingly se- umented workers, or for- vere tightness and pain of eign travelers may still pres- his jaw, chest, and abdom- ent with this potentially inal muscles. He stated lethal infection (10% to 2 that he was unable to open 20% mortality). his mouth, complained of Due to their appeal to Micrograph of Clostridium tetani bacteria. difficulty swallowing, and underserved or itinerant Source: Centers for Disease Control and Prevention Public Health Image Library (http://phil.cdc.gov). felt short of breath. patients, urgent care clini- MJ’s medical and surgi- cians may be called upon cal history was negative; he was taking no medica- to diagnose this uniquely dangerous condition more tions, and had no allergies. He was a non-smoker, rare frequently than those practicing in other settings, as alcohol drinker, and admitted to occasional (nasal) co- evidenced by the encounter detailed here. caine use. Born in Mexico, he had lived and worked in the Case United States for eight years. He was unaware of his MJ, a 25-year-old Hispanic male landscaper, presented childhood immunization history, and had never re- to the Cathedral Square Urgent Care Center in down- Introduction T w w w. j u c m . c o m JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | J a n u a r y 2 0 0 9 21