Unusual clinical course
Killen H. Briones-Claudett, Mónica H. Briones-Claudett, Roger A. Murillo Vasconez, Andrea Escudero-Requena, Killen H. Briones Zamora, Diana C. Briones Marquez, Jaime Benites Sólis, Michelle Grunauer
Faculty of Medical Sciences, University of Guayaquil, Guayaquil, Ecuador
Am J Case Rep 2020; 21:e923349
Available online: 2020-05-08
Tetanus is a potentially fatal infectious disease which, during its evolution, creates multiple complications, usually requiring intensive management and care.
CASE REPORT: We present a clinical case of a 59-year-old male patient with generalized tetanus admitted to the intensive care unit. Flexible bronchoscopy revealed contraction of the bronchial demonstrating that tetany existed at the respiratory level, which rarely becomes evident. The clinical manifestations included trismus, facial paralysis, neck stiffness, and compromised respiratory function. The patient presented a state of respiratory failure that required invasive mechanical ventilation which was evaluated by bronchoscopy and that showed spasms of the bronchial musculature. The patient presented generalized tetanus in which the bronchial affectation was evaluated by bronchoscopy in the intensive care unit. In developed countries, the anti-tetanus toxoid vaccine has ostensibly decreased its incidence, while it is endemic in developing countries, and although there are measures such as vaccination that try to reduce its incidence, in Ecuador there is an increase in incidences. In this patient case, contraction of the bronchial rings was observed, demonstrating that tetany existed at the respiratory level, which rarely becomes evident.
CONCLUSIONS: Although muscular contractions are widespread, this clinical case evidences bronchial spams reported and visualized by bronchoscopy.
Keywords: Bronchial Spasm, Clostridium tetani, Tetanus Toxin