Cephalic tetanus manifesting as isolated facial nerve palsy- a case report from rural Armenia

  • Armen Kishmiryan Presence St Francis Hospital, Amita Health, Evanston, IL, United States
  • Jeevan Gautam Institute of Medicine, Kathmandu, Nepal
  • Deeksha Acharya Srinivas Institute of Medical Sciences and Research Center, Mangalore, India
  • Bishnu Mohan Singh Patan Academy of Health Sciences, Lalitpur, Nepal
  • Armen Ohanyan Nork Infectious Clinical Hospital, Yerevan, Republic of Armenia
  • Anna Arakelyan Yerevan State Medical University After Mkhitar Heratsi, Yerevan, Republic of Armenia
  • Anush Vahanyan Yerevan State Medical University After Mkhitar Heratsi, Yerevan, Republic of Armenia
  • Sami Shoura John H. Stroger Jr Hospital of Cook County, Chicago, IL, United States
Keywords: Tetanus, facial nerve palsy, cephalic tetanus, cerebral tetanus

Abstract

Cephalic tetanus is a rare clinical form of tetanus, clinically characterized by trismus and cranial nerve palsy involving one or more cranial nerves, facial nerve being the most common. We report a case of cephalic tetanus with left-sided lower motor facial nerve palsy in a 66-year-old non-immunized patient after an untreated laceration injury. The patient had dysphagia, spasm of the muscles of mastication, asymmetry of the left side of the face, cough, shortness of breath, and stiffness of neck muscles. The presentation was unique given that the facial nerve palsy appeared prior to the occurrence of trismus, which misled the initial diagnosis towards Bell's palsy. He was successfully treated with tetanus antitoxin without any adverse events. Although widespread use of tetanus vaccine has led to a dramatic decline in this fatal disease, sporadic disease occurrence is still possible, particularly in individuals without up-to-date vaccinations. In this case report we illustrate the importance of early recognition of cephalic tetanus prior to the development of the full clinical picture. The early initiation of therapy is the key to recovery from this deadly disease. Physicians are encouraged to include cephalic tetanus as a cause of facial nerve palsy in their differential. In particular, paying attention to cases manifesting early after head or neck injury.

Published
2021-11-30
How to Cite
1.
KishmiryanA, Gautam J, AcharyaD, SinghBM, OhanyanA, Arakelyan A, Vahanyan A, Shoura S (2021) Cephalic tetanus manifesting as isolated facial nerve palsy- a case report from rural Armenia. J Infect Dev Ctries 15:1770-1773. doi: 10.3855/jidc.13817
Section
Case Reports