Autonomic Dysfunction as an Unusual Initial Presentation of Generalised Tetanus

In this paper, we report a rare case of a 65-year-old Chinese male farmer who was brought to an emergency department (ED) with a puncture wound on the left ankle. One week after being treated, the patient returned to the ED and exhibited signs of diaphoresis, hypertension, and slight rigidity and pain in the neck region. Eight hours after being admitted to the surgical ward, the patient developed typical signs of generalised tetanus, including abdominal muscle rigidity, trismus, and dysphagia. This case is unique because of the early manifestation of autonomic dysfunction, which is not common in people with tetanus. Therefore, to establish an early diagnosis of tetanus, physicians in EDs must obtain detailed patient histories and recognise acute changes in vital signs. (Hong Kong j.emerg.med. 2014;21:392-395)