Disclosures: Sierra Haq, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 38 year old male with history of IV heroin abuse.

Case Description: The patient presented with muscle rigidity, opisthotonus and trismus. Patient had a history of using black tar heroin, which can be contaminated with Clostridium tetani. He underwent testing to rule out strychnine poisoning, neuroleptic malignant syndrome, and botulinum poisoning. He was ultimately clinically diagnosed with tetanus, as a diagnosis of exclusion based on his history. He was treated with tetanus toxoid and immunoglobulin.

Setting: Tertiary care hospital.Assessment/

Results: Functional status improved greatly during rehabilitation stay. Patient progressed to walking 600 feet with rolling walker with supervision. He progressed to being independent in feeding, bathing, and donning shirt/pants/socks. He progressed to near full jaw range of motion with speech therapy.

Discussion: The patient’s acute hospital course was notable for prolonged intubation, ongoing rigidity, and autonomic instability thought to be related to tetanus. He required Nimbex for over one month for spasms and rigidity as well as relatively high doses of sedation. He had difficulty weaning from mechanical ventilation and underwent tracheostomy placement. He was clinically diagnosed with critical illness myopathy. He was admitted to an inpatient rehabilitation facility (IRF) two months after initial presentation. In the week prior to his IRF admission he functionally required moderate to maximum assistance with two people for gait and bed mobility. At time of IRF admission, he demonstrated decreased jaw range of motion, diffuse muscle atrophy, proximal weakness, tracheostomy dependence, and dysphagia. He was ultimately decannulated. He received treatment with buprenorphine from psychiatry service for heroin abuse. Targeted therapy strategies included activity tolerance, bilateral lower extremity range of motion, jaw range of motion, and safe swallow strategies

Conclusion: This is the first reported case, to our knowledge, of inpatient rehabilitation following tetanus infection in the United States.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/tetanus-trismus-and-tracheostomy-the-successful-rehabilitation-course-of-a-patient-with-tetany-in-present-day-united-states/