Silent Entry: The Diagnostic Challenge of Tetanus Without an Obvious Wound

Tetanus, caused by <i>Clostridium tetani</i>, is a significant health problem, particularly in regions lacking proper vaccination coverage against tetanus. Although it is usually associated with an identifiable wound, diagnosing tetanus without a visible entry site can be difficult. We report a 68-year-old man who was diagnosed with tetanus without any visible wounds or recent trauma. He had classic clinical features, including trismus, risus sardonicus, muscle spasms, and a positive spatula test, which all justified the clinical diagnosis of tetanus. The patient was treated with intramuscular injection of 3,000 IU of tetanus immune globulin, intravenous metronidazole, and muscle relaxants. He improved significantly after 10 days. He was discharged with follow-up and vaccination instructions. This case emphasizes the importance of maintaining a high index of suspicion for tetanus, even without any wound. It also reveals the effectiveness of clinical diagnostic methods and appropriate, timely treatment in rescuing the patient.