抜歯後発症した破傷風の1症例

A Rare Case of Tetanus after Teeth Extraction

　はじめに

　破傷風は，不潔な傷から体内に侵入した破傷風菌Clostridium telaniが外毒素tetanospasminを放出し，横紋筋の痙攣を生じる致死率の高い疾患である^1）。外傷の既往と全身の痙攣症状が認められれば診断は容易であるが，外傷を伴わない場合や部分的な症状のみ生じる場合もあり，この際に診断をつけることは難しい^2,3）。一方，近年の症例数激減^4）に伴い，破傷風に関する経験や情報を得る機会は極端に減っている。

　今回，外傷がなく抜歯後に発症し，診断に苦慮した破傷風症例を経験したので，文献的考察を加えて報告する。

A 77-year-old man was complaining of swallow-ing difficulty and speech disturbance, stiffness in the neck and lower extremities for three days.

He had teeth extraction six days before withouttaking antibiotics. On the initial examination, no respiratory disturbance and loss of consciousness and vocal cord rigidity were found.

The laboratory test revealed leukocytosis with neutrophilia, CRP and CPK elevation. The image findings denied any head and neck phlegmon or abscess.

A spinal tap showed no evidence of meningitis.

In consideration with clinical features and a neurosurgen's opinion, he was diagnosed as tetanus, and was transferred to the intensive care unit.