Jaw Stiffness in a Visitor from Rural Haiti

A 62-year-old woman from rural Haiti arrives in the United States to visit her daughter and meet her new grandchild. She is normally healthy and physically active, working regularly on a small farm. Three days after arrival, she develops difficulty chewing and describes a new stiffness of the jaw and mouth. She has never had similar symptoms before.

Through her daughter, she reports frequent minor cuts and abrasions while farming but does not recall one specific recent injury. She has no known chronic illnesses, takes no daily medications, and is unsure whether she ever received childhood vaccines. She denies headache, visual loss, limb weakness, fever, odynophagia, dental pain, or recent medication exposures.

Temperature is 36.8 degrees C, heart rate 84/min, blood pressure 128/74 mmHg, respiratory rate 16/min, and oxygen saturation 99% on room air. She is alert and speaking in full sentences. No cranial nerve deficit, facial asymmetry, neck swelling, pharyngeal abnormality, or focal neurologic deficit is identified. There is mild subjective discomfort with mouth opening, but no obvious dental abscess, temporomandibular joint tenderness, or visible wound. The remainder of the examination is unremarkable.

Laboratory studies show a white blood cell count of 6.4 x 10^9/L, hemoglobin 13.2 g/dL, platelets 231 x 10^9/L, sodium 139 mmol/L, creatinine 0.8 mg/dL, calcium 9.1 mg/dL, and glucose 94 mg/dL. Erythrocyte sedimentation rate is sent and pending. No other abnormal findings are identified.