CASE 66
A 9-day-old female newborn was taken to a hospital by her parents, who reported a 10-hour history of an inability to nurse and difficulty in opening her jaw.
PHYSICAL EXAMINATION
PE: The newborn had trismus, opisthotonus (Fig. 66-1), and hyper-responsiveness to external stimuli. The umbilical cord was covered with dry clay, which when retracted revealed a foul-smelling yellow-green discharge.
LABORATORY STUDIES
Diagnostic Work-Up
Table 66-1 lists the likely causes of illness (differential diagnosis). Tetanus is a clinical diagnosis. Electromyography may help in uncertainty, and cultures of umbilical stump wound may be necessary to determine the qualitative nature and extent of wound infection.
TABLE 66-1 Differential Diagnosis and Rationale for Inclusion (consideration)
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