Iqlima Idris1,2, Mohamad Masykurin Mafauzy1,2, Kamarul Aryffin Baharuddin1,2, Farah Alwi3, Wan Syahmi Wan Mohamad1,2

1Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia
2Hospital Universiti Sains Malaysia, Kelantan
3Department of Emergency and Traumatology, Hospital Seri Manjung, Perak, Malaysia

Keywords: Acute abdomen, creatine kinase, localized tetanus


Abdominal tetanus is the rarest presentation of localized tetanus in which other muscles are not involved. Proper diagnosis is challenging as it mimics acute abdomen. We describe the challenges in diagnosing this atypical localized tetanus in an adult and a review of case reports. Our patient is a 40 year old male who presented to the emergency department with generalized abdominal pain for 3 days. His physical examination revealed a guarded abdomen with tenderness in the epigastric region, while systemic examinations were unremarkable. The initial diagnosis was acute abdomen with suspected perforated viscus. Subsequently, he developed arching of the back on day 3 of admission with markedly elevated serum creatine kinase levels. A diagnosis of localized tetanus was made, and an uneventful recovery was achieved after management. Clinicians should be aware of the atypical presentations of abdominal tetanus as it mimics acute abdomen. Early recognition and initiation of treatment significantly reduce morbidity and mortality risks.

How to cite this article: Idris I, Mafauzy MM, Baharuddin KA, Alwi F, Mohamad WS. Localized tetanus mimics acute perforated viscus: A diagnostic challenge and review of case reports. Turk J Emerg Med 2022;22:226-9.

Author Contributions

II: writing – original draft (equal) and review and editing (equal). MMM: writing – original draft (lead) and review and editing (equal); KAB: writing – original draft (equal) and review and editing (lead); FA: writing – original draft (equal) and review and editing (supporting); WSWM: writing – original draft (supporting) and review and editing (supporting).

Conflict of Interest

None declared.

Financial Disclosure



The author(s) would like to thank the patient for his permission to publish this case report as well as the staff in Hospital Seri Manjung for their continuous support.