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Generalised tetanus in a patient with a chronic ulcerated skin lesion

BMJ 2009; 339 doi: (Published 13 November 2009) Cite this as: BMJ 2009;339:b4419

This article has a correction. Please see:

  1. Beatriz Aranegui, specialist registrar,
  2. Ángeles Flórez, dermatologist,
  3. Ignacio Garcia-Doval, dermatologist,
  4. Aránzazu García-Cruz, specialist registrar,
  5. Carlos de la Torre, dermatologist,
  6. Manuel Cruces, head of department
  1. 1Department of Dermatology, Hospital Provincial, Complexo Hospitalario de Pontevedra, 36002 Pontevedra, Spain
  1. Correspondence to: B Aranegui baranegui{at}
  • Accepted 6 June 2009

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

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

Case report

A 67 year old man was referred to the dermatology department with a two year history of skin lesions on his right leg. The patient was otherwise healthy and not taking any drugs. On physical examination he had painless subcutaneous nodules on the distal part of the right thigh (fig 1) and an asymptomatic eroded, scabbed, violaceous, well defined plaque on the upper side of the right ankle (fig 2]). He had no signs of infection, arterial or venous disease, or history of trauma. Possible diagnoses included lupus vulgaris or other mycobacterioses, necrobiosis, and sarcoidosis. Biopsy specimens were taken from both lesions in the operating theatre under standard aseptic conditions. The patient was told to care for the wounds by daily washing with water …

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