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Case of the Month -July 2017

Sandra D. Ngongang, Tom Boyles, Division of Infectious Diseases & HIV Medicine, Groote Schuur Hospital, Cape Town

A 49-year old man presented to Groote Schuur Hospital casualty with a 2-day history of difficulty opening and closing his mouth, and neck stiffness. Five days earlier he had stepped on a rusty nail. The patient reported a low-grade fever, pain of the left foot and rigid lower limbs. He had type 2diabetes mellitus, poorly controlled on metformin with diabetic retinopathy. His vaccination status was unknown.

On examination, he was conscious, had a temperature of 37.5°C, the pulse rate was 83 beats per minute, the blood pressure 120/70mmHg and the respiratory rate 20 breaths per minute. The patient had marked trismus, a stiff neck, and an infected wound on the left foot. He developed generalized spasms a few minutes after admission with airway obstruction, necessitating intubation and admission in ICU.

Question 1 - What is your differential diagnosis?

Continue to Answer 1