Boy With Muscle Spasms

A 10-year-old nonimmunized boy presented to the emergency department (ED) with severe muscle spasms and trismus. Two weeks before, he stepped on a stick while playing barefoot on his farm. His parents attempted home treatment with kerosene soaks. When he developed jaw pain, he was treated by a local physician and prescribed antibiotics for a local wound infection. As his pain and spasms worsened, his parents brought him to the ED, where the physical examination was notable for a pulse rate of 128 beats/min and a temperature of 101°F (38.3°C).

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