Case Report: A Challenging Case of Tetanus Presenting with Headache

Afiq Izzudin A. Rahim Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia;
Langkawi Health District Office, Kompleks LADA, Kuah, Langkawi, Kedah, Malaysia;

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Emir Afif Mohammad Azlan Communicable Disease Unit, Kedah Health State Department, Simpang Kuala, Jalan Kuala Kedah, Alor Setar, Kedah, Malaysia;

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Muhamad Ruslan Rahman Langkawi Health District Office, Kompleks LADA, Kuah, Langkawi, Kedah, Malaysia;

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Nafiisah Mahmud Pathi Langkawi Health District Office, Kompleks LADA, Kuah, Langkawi, Kedah, Malaysia;

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Mansor Ismail Langkawi Health District Office, Kompleks LADA, Kuah, Langkawi, Kedah, Malaysia;

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Wan Aliaa Wan Sulaiman Neurology Department, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia

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ABSTRACT.

Tetanus is a life-threatening infectious neurological condition that has become uncommon due to large-scale immunization campaigns. We describe a rare instance of generalized tetanus presenting with a headache on a tropical island in Malaysia. A 43-year-old woman presenting with headaches and generalized body weakness, which progressed into trismus and neck stiffness. Her medical history indicated a wound on the sole of her foot caused by shattered glass in an unhygienic area, but no tetanus prophylaxis had been administered. The patient was subsequently given immunoglobulin, tetanus toxoid, metronidazole, and sedatives in the recommended dosages. Her neurological condition improved remarkably, but she suffered blood pressure fluctuations due to dysautonomia. She was successfully discharged with complete recovery after 6 months of follow-up. The case demonstrates the significance of appropriate identification and care of tetanus, as well as the lethal effects of untreated wounds in vulnerable patients.

Author Notes

Authors’ addresses: Afiq Izzudin A. Rahim, Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia, and Langkawi Health District Office, Kompleks LADA, Kuah, Langkawi, Kedah, Malaysia, E-mail: afiqrahimusm@gmail.com. Emir Afif Mohammad Azlan, Communicable Disease Unit, Kedah Health State Department, Simpang Kuala, Jalan Kuala Kedah, Alor Setar, Kedah, Malaysia, E-mail: dremirafif@moh.gov.my. Muhamad Ruslan Rahman, Nafiisah Mahmud Pathi, and Mansor Ismail, Langkawi Health District Office, Kompleks LADA, Kuah, Langkawi, Kedah, Malaysia, E-mails: ruslanrahman@moh.gov.my, nafeesampt@gmail.com, and drmansor@moh.gov.my. Wan Aliaa Wan Sulaiman, Neurology Department, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia, E-mail: wanaliaa@upm.edu.my.

Address correspondence to Wan Aliaa Wan Sulaiman, Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia, 43400. E-mail: wanaliaa@upm.edu.my
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