A 65 years old man from Dyrab Nejm, Sharkia Governorate, Egypt with wound in the foot due to penetration by a nail was presented 2 weeks later by dysphagia, trismus (lock jaw), rigidity of the neck, limbs and abdominal muscles. There was no history of bite. Attacks of spasms (convulsions) with occasional cyanosis were noticed. The patients was admitted initially to Zagazig Fever Hospital, then the patient was referred to  Intensive Care Unit , Surgical Building , Zagazig University Hospitals, CSF examination was normal, tracheostomy was performed with aspiration of chest secretions and oxygen supply through it. Nasogastric tube (Ryle) was also difficulty introduced. The feeding was enteral .100,000 U equine antitetanic serum was administered intramuscularly in the first days of hospitalization after test for hypersensitivity . The patient was conscious with inability to talk. He wrote what he wanted. The patient was put in dark silent room. Diazepam in a dose of 20 mg/8 hrs infusion was administered for 3 weeks then tapered gradually. Intravenous muscle relaxants was administered for 4 weeks also chlorpromazin in a dose of 50 mg/8 hrs through the Ryle was administered in the first 2 weeks. Metronidazol 500 I.V. every 8 hrs for 10 days was administered as well as prophylactic macrolid antibiotic. By the end of 4 th week of illness the spasms ceased and the patient could talk but neck , abdominal and limbs rigidity were still present .