Abstract

Tetanus is an acute and potentially fatal infection caused by Clostridium tetani, characterized by profound neuromuscular involvement. Although effective treatment options remain limited, tetanus remains a significant public health concern because it is entirely preventable through vaccination. Here, we describe a case of generalized tetanus in a 21-year-old unvaccinated man who developed the disease after a nail puncture wound sustained at a construction site. The patient presented with classic manifestations, including trismus, risus sardonicus, generalized muscle rigidity, and autonomic instability. Despite prompt administration of tetanus vaccine, human tetanus immunoglobulin, and metronidazole, he experienced worsening muscle spasms and respiratory compromise that necessitated mechanical ventilation and deep sedation in the intensive care unit. His clinical course was further complicated by ventilator-associated pneumonia and subglottic stenosis related to prolonged intubation, the latter of which was successfully treated with bronchoscopic dilation. Following 70 days of intensive care and inpatient management, the patient recovered and was discharged. This case underscores the essential role of vaccination in preventing tetanus and highlights the complexities involved in the multidisciplinary management of severe tetanus.