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EM@3AM: Tetanus

A 38-year-old male with a history of injection drug use presents with one day of progressively worsening, pressure-like chest pain radiating to his back. He appears diaphoretic and in moderate distress. He has had new difficulty opening his mouth. On exam, he is tachycardic, diaphoretic, and in acute distress. He endorses tenderness throughout his thoraco-lumbar spine. Neurological evaluation demonstrated increased tone in all extremities. Skin exam reveals two abscesses on his upper extremities. An MRI of the spine is unremarkable. Reexamination reveals new spasmodic neck stiffening, jaw clenching and arching of his back. What is the likely diagnosis?