Generalised tetanus in a patient with a chronic ulcerated skin lesion

doi:10.1136/bmj.b4419

Published 13 November 2009, doi:10.1136/bmj.b4419
Cite this as: BMJ 2009;339:b4419

Practice

Lesson of the Week

Generalised tetanus in a patient with a chronic ulcerated skin lesion

Beatriz Aranegui, specialist registrar, Ángeles Flórez, dermatologist, Ignacio Garcia-Doval, dermatologist, Aránzazu García-Cruz, specialist registrar, Carlos de la Torre, dermatologist, Manuel Cruces, head of department

¹ Department of Dermatology, Hospital Provincial, Complexo Hospitalario de Pontevedra, 36002 Pontevedra, Spain

Correspondence to: B Aranegui baranegui@gmail.com

Chronic ulcerated skin lesions and skin biopsies should be consideredas wounds prone to tetanus

The first 150 words of the full text of this article appear below.

In developed countries, tetanus is uncommon and cases are usuallydiagnosed in elderly patients.¹ ² ³ ⁴ Levels of tetanus antibodiesare progressively lower with increasing age in groups over 50or 60 years old.⁴ ⁵ ⁶ ⁷ ⁸ Acute injuries and chronic woundscan allow entrance of Clostridium tetani.¹ ⁹ ¹⁰ ¹¹ We reportthe case of a non-immunised patient with generalised tetanusafter biopsy of a chronic ulcerated skin lesion.

A 67 year old man was referred to the dermatology departmentwith a two year history of skin lesions on his right leg. Thepatient was otherwise healthy and not taking any drugs. On physicalexamination he had painless subcutaneous nodules on the distalpart of the right thigh (fig 1) and an asymptomatic eroded,scabbed, violaceous, well defined plaque on the upper side ofthe right ankle (fig 2]). He had no signs of infection, arterialor venous disease, or history of trauma. Possible . . . [Full text of this article]