Unique Cases - Tetanus

 I wanted to share some of the unique cases I encountered during my time in Cavango over the next few posts!


    One day, a 7-year-old boy came into the clinic with a complaint of a stiff neck. He had classic nuchal rigidity - a textbook sign I had only read about until now, and it was incredible to see in person. Based on this, we initially suspected bacterial meningitis and admitted him to the ICU to begin treatment.

    Later that evening during rounds, we conducted a more thorough exam and realized something important: all of his muscles were rigid - not just his neck. The rigidity in his abdominal muscles was the key finding that led Dr. Tim to shift his concern from meningitis toward a diagnosis of tetanus.

    Back in the States, we would have quickly performed a lumbar puncture and run a CSF analysis to confirm or rule out meningitis. Unfortunately, we didn't have that kind of lab support available here. So, we moved forward based on clinical judgement and began treating for tetanus as well, adding corticosteroids and muscle relaxants to his care.

    Thankfully, the tetanus didn't progress further. He had no signs of respiratory distress or shortness of breath and was still able to eat and drink, even though his jaw was noticeably stiff. Each day, he improved - his rigidity lessened, his strength returned, and soon, he was walking again. It was a powerful reminder of the importance of sharp clinical skills, especially in resource-limited settings.

              

 


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