以腰膝痛、腹胀便秘为首发症状的一例先天性聋哑症破伤风感染案例报道并文献复习

Tetanus with Low back and Knee Pain,Abdominal Distension and Constipation as Initial Presentations:Report of a Deaf and Mute Case and Literature Review

破伤风是一种可致死性疾病,可以通过疫苗接种实现预防,破伤风的诊断完全基于病史和临床表现,容易误诊、误治、延误病情。本文报道了1例以腰痛、双膝关节痛、腹胀便秘为首发症状的聋哑症破伤风感染病例。该例患者以腰痛、双膝关节痛、腹胀便秘为首发症状前来骨伤疼痛科就诊,在治疗过程中发现患者存在污染创口外伤史,患者逐渐出现乏力、咯黄痰、颈项部僵硬不适、双侧颞颌关节疼痛、张口困难等症状,查体发现患者胸廓肌肉痉挛、腹肌紧张,颈部肌肉痉挛,诊断为破伤风,转入神经重症医学科进行破伤风抗毒素治疗及其他对症治疗,治疗22天后好转出院。提示临床医师需要重视并提高对破伤风的临床鉴别及诊疗能力,通过普及疫苗预防、污染创口外伤后及早免疫干预、及时诊断避免误诊、有效治疗有助于防治破伤风感染从而降低患者死亡率。

Tetanus is a life-threatening and fatal disease that can be prevented by vaccination.The diagnosis of tetanus is based solely on medical history and clinical symptoms and is very prone to misdiagnosis,undertreatment,and delayed treatment.We reported a deaf and mute patient with tetanus with low back pain,bilateral knee pain,and abdominal distension and constipation as the first symptoms.The patient visited the department of orthopedic pain management with low back pain,bilateral knee pain and abdominal distension and constipation as the chief complaint.During treatment,he was found to have symptoms such as fatigue,coughing with yellow sputum,neck stiffness and discomfort,bilateral temporomandibular joint pain and difficulty in opening the mouth gradually developed after a history of contaminated wound trauma,and thoracic muscle spasm,abdominal muscle tension and neck muscle spasm detected by physical examination,then he was diagnosed with tetanus and transferred to the neuro-ICU department for antitoxin treatment of tetanus and other symptomatic treatments,and discharged after 22-day treatment.Our case report and literature review suggest that to properly prevent and treat tetanus to reduce the risk of tetanus mortality,clinicians should strengthen the propaganda of preventing tetanus by preventive vaccination and timely vaccination after a contaminated traumatic wound,and pay attention to improve their capabilities of identifying,diagnosing and managing tetanus to reduce the possibility of misdiagnosis,and to timely deliver effective treatment after making a correct diagnosis.