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Clinical Review Lesson of the week

Tetanus in an immunised patient

BMJ 1999; 319 doi: (Published 16 October 1999) Cite this as: BMJ 1999;319:1049
  1. Zvi Shimoni, senior consultant, infectious disease unit,
  2. Anatoly Dobrousin, resident, department of internal medicine “B”,
  3. Jonathan Cohen, senior physician, intensive care unit,
  4. Silvio Pitlik, head, department of internal medicine “C” (
  1. Rabin Medical Center, Tel Aviv University, Petach Tikvah, Israel 49100
  1. Correspondence to: Dr S Pitlik, Department of Internal Medicine “C”, Rabin Medical Center, Beilinson Campus, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel 49100
  • Accepted 9 February 1999

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.

Case report

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 …

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