To the Editor.
—Holliday and Bauer (Archives 1983;40:56-57) described a patient in whom polyradiculoneuritis, and possible myelitis, developed within hours of immunization with tetanus and diphtheria toxoids, claiming a cause-and-effect relationship. They indicated that neurologic complications of immunization with combined tetanus and diphtheria toxoids have not been reported and concluded that tetanus toxoid was probably responsible for the adverse reaction. In fact, there have been reports of transverse myelitis1 and encephalitis2 after immunization with diphtheria and tetanus toxoids, but the more important issue is whether the tetanus toxoid immunization in this and other reports was responsible for the subsequent neurologic disorder.The only link between the immunization and the polyradiculoneuritis was the temporal relationship. That is not a strong link, as it seems unlikely that a widespread allergic reaction of the nervous system would develop within hours of immunization in the absence of systemic symptoms. There are rare
Fenichel GM. Neurologic Complications of Tetanus Toxoid. Arch Neurol. 1983;40(6):390. doi:10.1001/archneur.1983.04050060090020
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