Cargando…
Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea: A case report and brief literature review
RATIONALE: Tetanus is caused by a neurotoxin (tetanospasmin) secreted by a spore forming gram-positive, anaerobic rod-shaped motile bacillus, Clostridium tetani. The most common symptoms of tetanus are trismus (100%), dysphagia (70.5%), dysarthria (35.2%), and neck stiffness (29.4%). Respiratory fai...
Autores principales: | , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571262/ https://www.ncbi.nlm.nih.gov/pubmed/31169668 http://dx.doi.org/10.1097/MD.0000000000015652 |
_version_ | 1783427375511371776 |
---|---|
author | Park, Donghwi Kim, Jung Soo Heo, Sung Jae |
author_facet | Park, Donghwi Kim, Jung Soo Heo, Sung Jae |
author_sort | Park, Donghwi |
collection | PubMed |
description | RATIONALE: Tetanus is caused by a neurotoxin (tetanospasmin) secreted by a spore forming gram-positive, anaerobic rod-shaped motile bacillus, Clostridium tetani. The most common symptoms of tetanus are trismus (100%), dysphagia (70.5%), dysarthria (35.2%), and neck stiffness (29.4%). Respiratory failure, laryngeal spasm, seizure, chest pain, nausea/vomiting, opisthotonus, back pain, and rigid abdominal wall can also be observed during progression of the disease. However, there has been no report of periocular discomfort as an initial manifestation after endoscopic sleep surgery in a patient with tetanus. Here, we report a patient who underwent endoscopic sleep surgery with a concurrent diagnosis of tetanus infection presenting with atypical periocular discomfort as the initial symptom. PATIENT CONCERNS: A 63-year-old man complaining of sleep apnea, snoring, and daytime sleepiness visited our department. He subsequently underwent sleep surgery (anterior pharyngoplasty with tonsillectomy, septoplasty, microdebrider-assisted inferior turbinoplasty, and an endoscopic sinus surgery) for the treatment of his newly diagnosed obstructive sleep apnea. After 3 weeks of surgery, he visited the outpatient clinic of our department with right side periocular discomfort. DIAGNOSES: Four days after presenting with periocular discomfort, he was diagnosed with tetanus by presenting trismus, jaw pain, dysphagia, and ptosis at an emergency department of a different hospital. INTERVENTIONS: Tetanus immunoglobulin and antibiotics were administered. OUTCOMES: His symptoms then resolved after a month without sequelae. LESSONS: Although periocular discomfort is atypical and is not uncommon after nasal and oral surgeries, care should be taken when patients present with periocular pain because it could be a rare initial symptom of tetanus. |
format | Online Article Text |
id | pubmed-6571262 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-65712622019-07-22 Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea: A case report and brief literature review Park, Donghwi Kim, Jung Soo Heo, Sung Jae Medicine (Baltimore) Research Article RATIONALE: Tetanus is caused by a neurotoxin (tetanospasmin) secreted by a spore forming gram-positive, anaerobic rod-shaped motile bacillus, Clostridium tetani. The most common symptoms of tetanus are trismus (100%), dysphagia (70.5%), dysarthria (35.2%), and neck stiffness (29.4%). Respiratory failure, laryngeal spasm, seizure, chest pain, nausea/vomiting, opisthotonus, back pain, and rigid abdominal wall can also be observed during progression of the disease. However, there has been no report of periocular discomfort as an initial manifestation after endoscopic sleep surgery in a patient with tetanus. Here, we report a patient who underwent endoscopic sleep surgery with a concurrent diagnosis of tetanus infection presenting with atypical periocular discomfort as the initial symptom. PATIENT CONCERNS: A 63-year-old man complaining of sleep apnea, snoring, and daytime sleepiness visited our department. He subsequently underwent sleep surgery (anterior pharyngoplasty with tonsillectomy, septoplasty, microdebrider-assisted inferior turbinoplasty, and an endoscopic sinus surgery) for the treatment of his newly diagnosed obstructive sleep apnea. After 3 weeks of surgery, he visited the outpatient clinic of our department with right side periocular discomfort. DIAGNOSES: Four days after presenting with periocular discomfort, he was diagnosed with tetanus by presenting trismus, jaw pain, dysphagia, and ptosis at an emergency department of a different hospital. INTERVENTIONS: Tetanus immunoglobulin and antibiotics were administered. OUTCOMES: His symptoms then resolved after a month without sequelae. LESSONS: Although periocular discomfort is atypical and is not uncommon after nasal and oral surgeries, care should be taken when patients present with periocular pain because it could be a rare initial symptom of tetanus. Wolters Kluwer Health 2019-06-07 /pmc/articles/PMC6571262/ /pubmed/31169668 http://dx.doi.org/10.1097/MD.0000000000015652 Text en Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 |
spellingShingle | Research Article Park, Donghwi Kim, Jung Soo Heo, Sung Jae Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea: A case report and brief literature review |
title | Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea: A case report and brief literature review |
title_full | Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea: A case report and brief literature review |
title_fullStr | Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea: A case report and brief literature review |
title_full_unstemmed | Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea: A case report and brief literature review |
title_short | Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea: A case report and brief literature review |
title_sort | tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea: a case report and brief literature review |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571262/ https://www.ncbi.nlm.nih.gov/pubmed/31169668 http://dx.doi.org/10.1097/MD.0000000000015652 |
work_keys_str_mv | AT parkdonghwi tetanuspresentingprimarilyasperioculardiscomfortinapatientwhounderwentsurgeryforsleepapneaacasereportandbriefliteraturereview AT kimjungsoo tetanuspresentingprimarilyasperioculardiscomfortinapatientwhounderwentsurgeryforsleepapneaacasereportandbriefliteraturereview AT heosungjae tetanuspresentingprimarilyasperioculardiscomfortinapatientwhounderwentsurgeryforsleepapneaacasereportandbriefliteraturereview |