Generalised tetanus in an unvaccinated adult.

A 76-year-old previously well farmer presented having caught his left index finger in a gate. He gave no history of prior tetanus vaccination. The patient was treated in the emergency department; the wound cleaned, sutured and he was given tetanus toxoid prior to discharge. Eleven days later he represented unable to open his mouth. On examination he was noted to have trismus, generalised muscle spasms, diaphoresis and emotional lability and he was diagnosed with generalised tetanus.