A case of iliopsoas hematoma as a complication of tetanus in a patient who did not receive anticoagulant therapy

Abstract

Background: The specific clinical feature of tetanus is whole body muscle spasms. These spasms are intensely painful and sometime lead to some injuries. Vertebral fractures have been reported as a common complication of tetanus, however iliopsoas hematoma is a rare complication. We describe a case of iliopsoas hematoma in a tetanus patient who had not been treated with any anticoagulant or antiplatelet agents.

Case presentation: A 72-year-old female patient was transferred to our hospital 7 days after the onset of tetanus. An iliopsoas hematoma was identified in her right iliopsoas muscle on computed tomography. There was no extravasation; thus, the hematoma improved with conservative therapy. There were no episodes that suggested a bleeding tendency, or no factors associated with hemorrhagic conditions.

Conclusion: This is the first report of iliopsoas hematoma as a complication in a tetanus patient who did not received anticoagulation therapy. The possibility of IPH as a complication of tetanus should be considered before and during the administration of anticoagulation therapy.

Keywords: Anticoagulation therapy; Complication; Iliopsoas hematoma; Tetanus.

Fig. 1

a A 77-year-old woman with tetanus. Her mouth could not open no more than two finger breadths. b The patient’s right forearm was injured by a rose thorn. This wound, which was already covered with scabs, seemed to be the focus of tetanus infection

Fig. 2

There was no hematoma on day 4 (a). Right iliopsoas hematoma was unexpectedly found without extravasation on day 7. White arrows (↓) indicate hematoma in the right iliopsoas muscle (b). After conservative treatment, the iliopsoas hematoma become unclear on day 17 (c)