An immunohistochemical study on a tetanus fatal case using toxin fragment C (TTC). Should it be a useful diagnostic tool?

A 65-year-old man fell in his garden and sustained a right pre-radial cutaneous laceration associated with a Colles’ fracture. His status for tetanus immunization was uncer- tain; so a course of antitetanus treatment was immediately started. Two days after admission the man suddenly devel- oped severe nucal pain, rigidity and dysphagia. A brain CT scan was negative. His condition progressively worsened and then he developed trismus. Cultures from the wound were negative for Clostridium tetani; the CSF analysis was negative. On the 9th day after admission, the man died. A presumptive clinical diagnosis of tetanus was made. Autopsy was performed 24 h after death. An immunohis- tochemical study was conducted with an antibody directed against tetanus toxin fragment C (TTC). By immunohis- tochemical evaluation, large motor neurons in the ventral horn were immunopositive for TTC. High power magnifi- cation of the ventral horn of spinal cord gray matter samples showed TTC immunoreactivity in motor neuron axons and cell bodies, using a confocal laser scanning microscope. The correct diagnosis could be established on the basis of pathological examination with TTC immunostaining.