Tetanus in a Child Due to Otogenic Source: A Case Report with Review of Literature

Abstract

Background: In adults, tetanus typically follows trauma, while in children, it often results from ear infection. Clinical Description: A 7-year-old boy presented with difficulty opening his mouth and generalized rigidity, developing over 10 days. He had a history of left ear discharge for a month, but no associated headache, vomiting, and abnormal movements. He was unvaccinated except for the birth dose. On examination, he was conscious and afebrile, but presented with generalized stiffness, risus sardonicus, and tachycardia, maintaining oxygen saturation. Management and Outcome: Tetanus was suspected clinically, and the child was kept in a sound-proof, dark isolation room. Equine immunoglobulin 10,000 IU and tetanus toxoid vaccine along with intravenous antibiotics were administered. Muscle spasms were managed with diazepam, chlorpromazine, and phenobarbitone. Clostridium tetani was confirmed from an ear swab culture. The child’s muscle rigidity and spasms gradually decreased after 3 weeks, with improved oral intake. Intravenous sedation was transitioned to oral antispasmodics and he was discharged in a normal neurological status with no residual spasms. Conclusion: Tetanus in children is not obsolete, and needs to be kept in mind in case of chronic suppurative otitis media.