Generalized Tetanus in an Unvaccinated Adolescent: A Case Report on Successful Management in a Resource-Limited Setting

Background: . Among its clinical forms, cephalic tetanus is the rarest, representing only 1-3% of cases. It is typically characterized by cranial nerve involvement, rapid progression to generalized tetanus, and a high risk of mortality. Case Presentation: We describe the case of a 17-year-old male with no prior tetanus vaccination who presented with trismus, painful muscle spasms, and opisthotonos following a traumatic head injury. Laboratory findings showed leukocytosis, electrolyte disturbances, and raised inflammatory markers.Management included urgent wound debridement, administration Antibiotics and tetanus immunoglobulin. Intensive sedation was required to control recurrent spasms. Due to respiratory compromise, the patient was intubated and subsequently underwent tracheostomy. After an extended stay in the intensive care unit (ICU), gradual weaning from both sedation and mechanical ventilation was achieved. He was ultimately discharged in stable condition with full neurological recovery. Discussion: This case illustrates the aggressive course of Generalized tetanus and highlights the critical importance of early airway protection. Tracheostomy proved essential in reducing morbidity and facilitating prolonged ventilatory support. Despite limited resources, coordinated multidisciplinary ICU care, including physiotherapy, contributed significantly to the patient's favorable outcome. Conclusion: This case shows that generalized tetanus remains a serious but entirely preventable disease, occurring mainly in individuals who are not vaccinated. It highlights how early recognition, prompt antitoxin therapy, careful intensive care management, and timely airway intervention can lead to good outcomes, even in resource-limited settings. Above all, it reinforces vaccination as the most effective and lasting measure to prevent tetanus and reduce its associated morbidity and mortality.