Generalized tetanus in a patient with a diabetic foot infection

Tetanus is a preventable disease that continues to affect people in the Uni ted States due to poor immunization practices in our health care system. A 57-year-old man with type 2 diabetes mellitus, hypertension, and end-stage renal disease with many hospital admissions came to the hospital emergency department because of a blackened great toe. He denied pain in the toe or k nowledge of foot injury. The patient also complained of temporomandibular t enderness accompanied by inability to open his mouth completely. The man's problems progressed to generalized tetanus and required a long hospitalizat ion. Clostridium tetani can flourish in the anaerobic environment of a diab etic foot infection. Practitioners should be aware of tetanus as a rare but potentially serious complication of diabetic foot infections.