Tropical Travel Trouble 003 Stiff in the Mouth

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog aka Tropical Travel Trouble 003 A 65 yr old woman from Ethiopia is visiting her grandchild for the first time in Europe. She is normally fit and well, physically active with a small-holding in Ethiopia. She does not take any medication and cannot remember the last time she saw a doctor. She presents to you with difficulty chewing 3 days after arriving in the UK. She describes it as being “stiff in the mouth” Questions: Q1. What is the differential diagnosis and how would you diagnose each? Answer and interpretation expand(document.getElementById('ddet1785030685'));expand(document.getElementById('ddetlink1785030685')) Tetanus – clinical diagnosis and the one present in this case. Bacteriology is of little help, the organism is often not found and a positive wound culture for C. tetani does not prove that the organism is toxin producing. Giant cell arterititis – ESR Dental abscess – examination Strychnine poisoning – history, most likely this will be of sudden onset and continuous, urinary levels can be obtained. Supportive care should be initiated. See Tox library – Strychnine poisoning. Dystonic reactions – drug history, trial of benzatropine Stiff person syndrome – most likely a diagnosis of exclusion but the presence of antibodies against GAD is the best indication of...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Clinical Cases Tropical Medicine tetanus Source Type: blogs