A 49-year-old male intravenous drug addict attended the emergency department complaining of ‘shortness of breath’ for one day. He was discharged after evaluation and referred to the methadone clinic. He re-attended the next day complaining of neck stiffness and twitching of limbs for one day. The final diagnosis was tetanus. Although tetanus is rare in Hong Kong, high vigilance should still be maintained for its atypical presentations, especially in high-risk groups.
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