RESUMEN
A 55-year-old man underwent radiation therapy due to malignant lymphoma of the neck. Eight years after the therapy he developed tetanus. It appears that the radiation therapy resulted in mandibular necrosis, and that this lesion may have been the infectious focus of tetanus. Treatment with penicillin G was very effective in the acute stage, and chronic administration of metronidazole prevented relapse of the disease. However in spite of injections of tetanus toxoid, symptoms of tetanus returned when the administration of metronidazole was discontinued because the infectious focus could not be completely removed. This is the first report of chronic relapsing tetanus associated with radiation-induced mandibular osteomyelitis, and demonstrates that tetanus can occur due to mandibular focus but the chronic administration of metronidazole can prevent relapse.
Asunto(s)
Enfermedades Mandibulares/complicaciones , Osteomielitis/complicaciones , Tétanos/complicaciones , Antibacterianos/uso terapéutico , Enfermedad Crónica , Radioisótopos de Galio , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Linfoma de Células B/radioterapia , Masculino , Enfermedades Mandibulares/diagnóstico por imagen , Enfermedades Mandibulares/etiología , Metronidazol/uso terapéutico , Persona de Mediana Edad , Osteomielitis/diagnóstico por imagen , Osteomielitis/etiología , Traumatismos por Radiación/complicaciones , Cintigrafía , Recurrencia , Tétanos/diagnóstico por imagen , Tétanos/tratamiento farmacológico , Tétanos/etiologíaRESUMEN
A 7 day delay occurred in the diagnosis of cephalic tetanus in a 69 year old woman who developed an ipsilateral facial palsy 5 days after a facial laceration. Cranial nerve palsies often precede trismus in this form of tetanus.
Asunto(s)
Parálisis Facial/etiología , Tétanos/diagnóstico por imagen , Anciano , Diagnóstico Diferencial , Errores Diagnósticos , Inglaterra , Femenino , Humanos , Radiografía , Tétanos/complicaciones , Factores de Tiempo , GalesRESUMEN
The chest and abdominal radiographs of 11 infants with neonatal tetanus were reviewed. There was no case of vertebral body fracture, although the intervertebral spaces were narrowed in 2 cases and different spinal curvatures were observed. Gasless abdomen and air esophagogram were seen in 4 and 5 patients, respectively. These are thought to be due to the effect of phenobarbitone and diazepam sedation. Almost all infants had pulmonary infiltrates which are presumed to be due to aspiration of abdominal contents.