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Neurological picture
Acute camptocormia as the presenting symptom of tetanus
  1. Seiji Kaji,
  2. Hidehiro Shibayama,
  3. Susumu Sato,
  4. Toshio Fukutake
  1. Department of Neurology, Kameda Medical Center, Kamogawa-shi, Chiba prefecture, Japan
  1. Correspondence to Dr Seiji Kaji, Department of Neurology, Kameda Medical Center, 929, Higashi-cho, Kamogawa-shi, Chiba prefecture 296-0041, Japan; seiji-kaji{at}hotmail.co.jp

https://doi.org/10.1136/jnnp-2013-306743

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    Introduction

    Opisthotonus is one of the representative presenting symptoms seen among patients with tetanus, as well as pain, stiffness, rigidity and spasms.1 We report an unusual case of tetanus with camptocormia as the initial symptom.

    Case presentation

    A 77-year-old female farmer with unremarkable medical history arrived at our hospital due to difficulty in swallowing and a dropped head which were noticed 4 days prior to the visit. On examination at arrival, she had camptocormia with increased tonus of rectus abdominis muscle. She also had hoarseness in speech and mild limitation in opening her mouth. No wound was observed.

    Investigation

    On laryngoscopy, saliva was pooling around the epiglottis with decreased mobility. Therefore, she was admitted to the intensive care unit.

    Clinical course

    On the 4th day of admission, her trismus deteriorated rapidly. With a tentative diagnosis of tetanus, she was given tetanus vaccine and human …

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    Footnotes

    • Contributors SK, HS, SS and TF all identified the patient. SK wrote the original draft of the manuscript, with important contributions from HS, SS and TF. All authors provided input into the final manuscript.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.