Abstract
BackgroundReactive arthritis had been reported to occur after various vaccinations, including the tetanus toxoid vaccine; here, we report a case of ankylosing arthropathy suggested to be a complication of missed neglected reactive arthritis after tetanus infection.Case presentationA healthy 20-year-old woman presented with subtrochanteric right femoral fracture; imaging studies showed bilateral ankylosed hip, kyphoscoliosis, bilateral fused temporomandibular joints, and normal sacroiliac joints bilaterally. Laboratory investigations for a rheumatic or autoimmune disease were all within normal ranges. Detailed history revealed admission of the patient to an ICU unit (1 year before the trauma) for a month as she was diagnosed as having tetanus infection, after which she was unable to walk or feed herself. At the final follow-up, the patient started walking with a moderate limb after having a series of surgeries including femoral fracture fixation, temporomandibular joint excision arthroplasty, and bilateral total hip arthroplasty.ConclusionUnusual complications after tetanus infection can occur in the form of joint ankylosis, which could be presented after prolonged immobilization possibly due to improper management of reactive arthritis.
Highlights
BackgroundTetanus infection is caused by Clostridium tetani, which is a gram-positive, spore-forming anaerobic bacillus; infection route may be through skin laceration or a direct inoculation by contaminated surgical instruments [1]
Reactive arthritis had been reported to occur after various vaccinations, including the tetanus toxoid vaccine; here, we report a case of ankylosing arthropathy suggested to be a complication of missed neglected reactive arthritis after tetanus infection.Case presentation: A healthy 20-year-old woman presented with subtrochanteric right femoral fracture; imaging studies showed bilateral ankylosed hip, kyphoscoliosis, bilateral fused temporomandibular joints, and normal sacroiliac joints bilaterally
Development of Reactive arthritis (ReA) had been reported after administration of various vaccinations, including influenza, rabies, bacillus Calmette–Guerin (BCG), and tetanus vaccines in few case reports [5,6,7,8]; to the best of our knowledge, it had not been reported after a tetanus infection
Summary
Tetanus infection is caused by Clostridium tetani, which is a gram-positive, spore-forming anaerobic bacillus; infection route may be through skin laceration or a direct inoculation by contaminated surgical instruments [1]. After about 10 days, she developed an attack of toniccolonic convulsions, upon which she was admitted to the ICU for a month She was diagnosed as having tetanus (they have no documentation to prove the diagnosis); after discharge from the ICU, the patient had stiffness of both lower limbs with difficulty in walking (became wheelchair-bound) and the inability to mouth feeding (upon which the patient received an endogastric tube for feeding). The patient was transferred to the inpatient ward for consultation with a rheumatologist regarding the patient’s history and the atypical affection of the hip joints and spine He suggested the possibility of a seronegative spondylarthritis; laboratory investigations in the form of anti-nuclear antibody, HLA-B27, uric acid, hemoglobin, C3 and C4 complement, alanine aminotransferase, aspartate aminotransferase, sodium, potassium, urea, creatinine, urine analysis, and glucose were all within their normal ranges. At the final follow-up, the radiographs showed an acceptable position of both THA with the progression of the spinal deformity (Fig. 3); the patient was satisfied with the results of the surgeries; she is talking and eating properly and walking without assistance with a moderate limb
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