Tetanus mimicking post-radiotherapy dysphagia in a head and neck cancer survivor:A case report with institutional review.

Tetanus is a rare but potentially fatal infectious disease caused by Clostridium tetani, characterized by muscle rigidity, trismus, and dysphagia. We report a case of tetanus mimicking post-radiotherapy dysphagia in a 68-year-old male with a history of hypopharyngeal and esophageal cancers treated with chemoradiotherapy. The patient presented with acute-onset dysphagia and speech difficulty, which were initially attributed to radiation-induced sequelae. Because dysphagia and pharyngeal discomfort are common complaints in post-chemoradiotherapy patients, and laryngoscopic findings were unchanged from his recent baseline, multiple physicians-including head and neck cancer specialists-did not suspect tetanus on the initial visit. Detailed history-taking on the following day revealed a preceding hand injury, leading to a diagnosis of tetanus. Clinical examination revealed trismus with an interincisal distance of 20 mm. The patient required endotracheal intubation due to hypercapnia and anticipated airway compromise from progressive trismus, and subsequently underwent tracheostomy, but eventually recovered full oral intake (Functional Outcome Swallowing Scale Grade 0) after intensive swallowing rehabilitation. Additionally, we reviewed eight tetanus cases treated at our institution over the past decade. Of these, 87.5% required endotracheal intubation, 75.0% underwent tracheostomy, and 50.0% had persistent dysphagia at discharge. This case underscores the importance of obtaining a thorough trauma history in head and neck cancer survivors presenting with rapidly progressive dysphagia, as tetanus-induced symptoms can closely resemble post-radiation sequelae.