Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. e1355-e1358 (doi:10.1542/peds.2006-3386)
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EXPERIENCE & REASON

Atypical Tetanus in a Completely Immunized 14-Year-Old Boy

Kai König, MDa, Hannelore Ringe, MDa, Brigitte G. Dorner, PhDb, Alexander Diers, MDa, Birgit Uhlenberg, MDa, Dominik Müller, MDa, Verena Varnholt, MDa and Gerhard Gaedicke, MDa

a Children's Hospital, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
b Robert Koch Institute, Microbial Toxins, Center for Biological Safety, Berlin, Germany

ABSTRACT

We report the uncommon clinical course of tetanus in a completely immunized 14-year-old boy. His initial symptoms, which included a flaccid paralysis, supported a diagnosis of botulism. Preliminary mouse-test results with combined botulinum antitoxins A, B, and E, obtained from tetanus-immunized horses, backed this diagnosis. The change in his clinical course from paralysis to rigor and the negative, more specific, botulinum mouse test with isolated botulinum antitoxins A, B, and E, obtained from nonvaccinated rabbits, disproved the diagnosis of botulism. Tetanus was suspected despite complete vaccination. The final results of a positive mouse test performed with isolated tetanus antitoxin confirmed the diagnosis. Adequate treatment was begun, and the boy recovered completely.

Key Words: tetanus • botulism • infection • immunization • paralysis • mouse toxicity test

Abbreviations: IgG, immunoglobulin G

Accepted Apr 17, 2007.