Aya Katasako

An 80-year-old Japanese man attended our hospital with a 3-day history of stiffness in his jaw and difficulty moving his right arm. He had no history of ever travelling abroad, but he did have a medical history of hypertension, osteoporosis, and total gastrectomy due to gastric carcinoma. He told us that he had hurt his right hand while working in his garden 10 days ago. On physical examination, we found him to have a stiff neck, trismus, and a fixed sardonic-type smile (figure).