Tongue piercing ... The new "rusty nail"?

Background. Cephalic tetanus rsa rare form of the tetanus caused primarily by wounds or other infectious processes involving the head and neck. This c ondition frequently progresses to the generalized form of tetanus with the attendant risks and complications. Methods. A case report of a young female who developed an unusual form of t etanus after a tongue piercing is presented here. We discuss this disorder as it applies to the contemporary caregiver with a focus on its presentatio n and recognition. giver with a focus on its presentation and recognition. Results. A delay in diagnosis of 13 days from presentation occurred. The patient had a slow, u neventful but incomplete recovery course. She never developed significant a irway compromise, nor did she demonstrate any evidence of hemodynamic insta bility but continued to have right facial weakness up to 6 months after dis charge. Conclusions. A few factors were identified that contributed to the signific ant delay in diagnosis. The unusual nature of the disease and a lowered ind ex of suspicion on the part of the initial caregivers were probably the maj or causes. Fortunately, no major adverse sequelae resulted from the delay. However, ii this case heralds the onset of a rise in the incidence of tetan us, early recognition and diagnosis would seem essential to avoid much of t he morbidity and mortality associated with the disease. (C) 2000 John Wiley & Sons, Inc.