J Korean Surg Soc.  2009 Apr;76(4):259-261. 10.4174/jkss.2009.76.4.259.

Tetanus in a Breast Cancer Patient with Adjuvant Chemotherapy

• Kim KH
• Kim HY
• Jung JW
• Jung YS
• Jun HM
• Park WC

• KMID: 1465065
• DOI: http://doi.org/10.4174/jkss.2009.76.4.259

Abstract

Tetanus is a neurologic disorder caused by a tetanoplasmin which is a neurotoxin elaborated by Clostridium tetani. It is characterized by increased muscle tone and spasm. Since a nationwide childhood vaccination program, tetanus has become a rare disease in Korea. Because many physicians have little experience, misdiagnosis or therapeutic delay may result in unexpected consequences. Although it has high mortality rate on attack, early detection, proper immunization and supportive care can increase survival rate. We report a case of tetanus due to puncture injury by splinter in a 69-year-old woman who has been treated with adjuvant chemotherapy of breast cancer. She was admitted to emergency room with difficulty of opening mouth for 3 days. After two days, we detected that the patient suddenly fell on her back with muscle spasm, so we diagnosed her with tetanus. She was given human tetanus immunoglobulin intramuscularly and supportive care. Forty days after admission, she was discharged without complications.

Keyword

Tetanus; Breast cancer; Chemotherapy

MeSH Terms

Aged
Breast
Breast Neoplasms
Chemotherapy, Adjuvant
Clostridium tetani
Diagnostic Errors
Emergencies
Female
Humans
Immunization
Immunoglobulins
Korea
Mouth
Muscles
Nervous System Diseases
Punctures
Rare Diseases
Spasm
Survival Rate
Tetanus
Vaccination
Immunoglobulins

Reference

1. Lee DH. Past, present and future of the national immunization program. Korean J Infect Dis. 1995. 27:213–219.

2. Dittrich KC, Keilany B. Tetanus: lest we forget. CJEM. 2001. 3:47–50.

3. Wright DK, Lalloo UG, Nayiager S, Govender P. Autonomic nervous system dysfunction in severe tetanus: current perspectives. Crit Care Med. 1989. 17:371–375.

4. LaForce FM, Young LS, Bennett JV. Tetanus in the United States (1965-1966): epidemiologic and clinical features. N Engl J Med. 1969. 280:569–574.

5. Kim SK, Choi SC, Cho TH. A clinical analysis on tetanus. J Korean Surg Soc. 1988. 34:17–23.

6. Farrar JJ, Yen LM, Cook T, Fairweather N, Binh N, Parry J, et al. Tetanus. J Neurol Neurosurg Psychiatry. 2000. 69:292–301.

7. Sternlo JE, Andersen LW. Early treatment of mild tetanus with dantrolene. Intensive Care Med. 1990. 16:345–346.

8. Sanford JP. Tetanus--forgotten but not gone. N Engl J Med. 1995. 332:812–813.

9. Bunch TJ, Thalji MK, Pellikka PA, Aksamit TR. Respiratory failure in tetanus: case report and review of a 25-year experience. Chest. 2002. 122:1488–1492.

10. Yu J, Chou AJ, Lennox A, Kleiman P, Wexler LH, Meyers PA, et al. Loss of antibody titers and effectiveness of revaccination in post-chemotherapy pediatric sarcoma patients. Pediatr Blood Cancer. 2007. 49:656–660.