Tetanus after needle puncture for self‐monitoring of blood glucose: A case report

We report a case of tetanus in a 77‐year‐old man with type 2 diabetes. His diabetes was being managed with insulin injections and self‐monitoring of blood glucose. He presented to our emergency department with a 2‐week history of worsening myalgia. On examination, he had trismus, severe spasms and opisthotonus. We diagnosed tetanus and started treatment with human tetanus immunoglobulin, ampicillin, and magnesium, but he required an artificial respirator. The muscle spasms continued for a long term, but gradually improved. He was weaned from the respirator after 6 weeks. The patient was discharged in an ambulatory status 3 months after admission. On review, the he reported gardening barehanded after carrying out needle puncture of a finger to monitor the blood glucose. We speculate that this needle puncture could have resulted in tetanus infection. The present case shows that tetanus infection can occur after needle puncture for self‐monitoring of blood glucose.