Homicidal death following blunt trauma in a vulnerable host, with secondary infections including local tetanus

An uncommon type of homicide resulted from complications of an ordinarily nonfatal injury after a 59-year-old obese, hypertensive, diabetic man was struck in the face with a two-by-four, sustaining a grossly contaminated laceration. It was cleaned and sutured primarily, and a tetanus booster was given. On the fourth hospital day there was evidence of anerobic wound cellulitis, including Clostridium tetani. The wound was surgically debrided, but 2 days later the patient developed local tetanus. Only then was it discovered that he had never been immunized against tetanus. He did not develop systemic tetanus, but 2 days later he died with bronchopneumonia and sepsis. The assailant was indicted for involuntary manslaughter, but after a contentious trial he pleaded "no contest" to a reduced charge. The decedent was a vulnerable host, his contaminated facial laceration initiating an unbroken course of events that led to his death.