BACKGROUND: Severe tetanus necessitates high-dose sedatives and analgesics. However, conventional pharmacotherapy is limited, particularly when the disease is complicated by a sympathetic storm. Herein, we report a case of severe tetanus complicated by a refractory sympathetic storm that was successfully aborted with ultrasound-guided stellate ganglion block (SGB). SGB can be a valuable rescue therapy for this life-threatening autonomic complication, offering a potentially effective therapeutic option when standard medical management fails.

CASE REPORT: A 67-year-old man presented to our hospital with a several-day history of progressive symptoms following a puncture wound to the middle finger of his left hand caused by a bamboo skewer. The foreign body had remained embedded for 3 days before being self-removed by the patient, without any subsequent systematic medical treatment. He subsequently developed neck stiffness, dysphagia, pallor, and cyanosis, leading to hospital admission. Upon admission, emergency management included endotracheal intubation, wound debridement, and administration of tetanus toxoid vaccine and human tetanus immunoglobulin. However, the combination of standard sedatives, analgesics, and muscle relaxants proved insufficient to control recurrent convulsions and sympathetic storm. An ultrasound-guided left SGB was therefore performed, which effectively aborted the sympathetic storm.

CONCLUSIONS: SGB can offer life-saving potential or clinical value for patients with severe tetanus who exhibit refractory sympathetic hyperactivity despite standard treatment. However, the causal relationship and general applicability of this intervention require further validation through additional clinical studies.

Keywords: Case Reports, Stellate Ganglion, Sympathetic Nervous System, tetanus