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June 5, 1967

Tetanus Mimicking Psychophysiologic Reaction: Occurrence After Dental Extraction

Author Affiliations

From the Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill.

JAMA. 1967;200(10):891-892. doi:10.1001/jama.1967.03120230143030

THE FOLLOWING CASE is presented for three reasons. First, the wound of dental extraction is a relatively rare and usually unconsidered portal of entry for the tetanus organism. Graves in 1930 reported three cases of tetanus after dental extraction.1 Three years later Appleton was able to find only three additional cases reported in the literature and attributed the infection to inadequate sterilization of dental instruments.2 Griswold and Herring in 1949 described a patient with tetanus following dental extraction who was initially thought to be hysterical.3 Shershin and Katz in 1964 reported an additional case and gave references to two other case reports in the world literature.4

Second, the symptoms of the patient's tetanus infection accurately mimicked in exaggerated form symptoms which had long been present on presumably a psychophysiologic basis. Thus, diagnosis of tetanus was delayed.

Third, as part of a survey project the patient's ankle