Dilip R. Karnad, MD; G.H. Tilve, MD
To the Editors: Malignant tumors undergo necrosis or ulceration when cell division outgrows vascular supply (1), and the hypoxic necrotic region then provides optimal conditions for growth of anaerobic clostridia (2, 3). Experimental injection of spores of Clostridium tetani can cause tetanus in mice with necrotic malignant tumors (2). However, tetanus in patients with malignancies is not known. We report the cases of seven such patients.
A 50-year-old man with dysphagia had an ulcerated squamous cell carcinoma on the posterior third of his tongue. He developed moderately severe tetanus 1 month after onset of dysphagia. Patient 2, a 58-year-old woman,
Karnad DR, Tilve G. Tetanus from Ulcerated Tumors. Ann Intern Med. ;113:170–171. doi: 10.7326/0003-4819-113-2-170_2
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Published: Ann Intern Med. 1990;113(2):170-171.
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