A case of iliopsoas hematoma as a complication of tetanus in a patient who did not receive anticoagulant therapy
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CASE REPORT
Open Access
A case of iliopsoas hematoma as a complication of tetanus in a patient who did not receive anticoagulant therapy Hiroki Nagasawa* , Ken-ichi Muramatsu, Ikuto Takeuchi, Yoshihiro Kushida, Kei Jitsuiki, Jun Shitara, Hiromichi Ohsaka, Kazuhiko Omori, Yasumasa Oode and Youichi Yanagawa
Abstract Background: The specific clinical feature of tetanus is whole body muscle spasms. These spasms are intensely painful and sometime lead to some injuries. Vertebral fractures have been reported as a common complication of tetanus, however iliopsoas hematoma is a rare complication. We describe a case of iliopsoas hematoma in a tetanus patient who had not been treated with any anticoagulant or antiplatelet agents. Case presentation: A 72-year-old female patient was transferred to our hospital 7 days after the onset of tetanus. An iliopsoas hematoma was identified in her right iliopsoas muscle on computed tomography. There was no extravasation; thus, the hematoma improved with conservative therapy. There were no episodes that suggested a bleeding tendency, or no factors associated with hemorrhagic conditions. Conclusion: This is the first report of iliopsoas hematoma as a complication in a tetanus patient who did not received anticoagulation therapy. The possibility of IPH as a complication of tetanus should be considered before and during the administration of anticoagulation therapy. Keywords: Tetanus, Iliopsoas hematoma, Complication, Anticoagulation therapy
Background Tetanus, a disease that has killed many people since ancient times is caused by tetanospasmin, a toxin produced by Clostridium tetani, which is widely distributed in soil and the human intestines. On the other hand, the neurological prognosis is relatively good. The specific clinical feature of tetanus is whole body muscle spasms (e.g., lock jaw and opisthotonus); these spasms are intensely painful and sometime lead to bone fracture [1]. Common complications of tetanus include hospitalacquired pneumonia (HAP), ventilator-associated pneumonia (VAP), infections (e.g., sepsis), deep vein thrombosis (DVT), pulmonary thromboembolism (PTE) and * Correspondence: [email protected] Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295, Japan
upper gastrointestinal hemorrhage [1, 2]. Vertebral fractures have previously been reported as a complication of opisthotonus [1, 3, 4]. However, iliopsoas hematoma (IPH) is a rare complication of tetanus, with only one report of IPH in a tetanus patient who was treated with anticoagulant therapy to prevent DVT/PTE [5]. We herein describe a case of iliopsoas hematoma in a tetanus patient who had not been treated with any anticoagulant or antiplatelet agents.
Case presentation A 72-year-old female patient, who was not prescribed any medications, without any relevant medical history, was transported to our hospital due to suspected tetanus. She had never been vaccinated against tetanus. Fourteen days previously, she had been
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