Picking The Odd One Out: Cephalic Tetanus – A Case Report From Rural Pakistan

Abstract

Tetanus is an infectious disease with a high risk of mortality. It is caused by an exotoxin, tetnospasmin, produced
by Clostridium tetani, an anaerobic gram positive bacillus. The risk of disease is high in the general population
due to the abundance of spores in the environment. There are four clinical types of tetanus, generalized, localized,
neonatal and cephalic. Cephalic tetanus is one of the rarest clinical form that presents with trismus and cranial
nerve involvement. Cephalic tetanus can be difficult to diagnose since it doesn't often manifest with the typical tetanus symptoms like muscle spasms and stiffness. This case is of a 55 year old male who presented to a tertiary care hospital with symptoms consistent with Bell's palsy for 5 days that progressed to development of trismus and neck muscle stiffness with difficulty of breathing that lead to his referral from rural healthcare setup. The case highlights the importance of detailed history and examination with high grade suspicion to make a clinical diagnosis of cephalic tetanus in a country with epidemiological evidence of disease.
Keywords: Cephalic tetanus, Bell 's palsy, Infectious disease