Neurologic Complications of Tetanus Toxoid

To the Editor.  —We wish to respond to the letter by Gerald M. Fenichel, MD (Archives 1983;40:390) concerning "Polyradiculoneuritis Secondary to Immunization With Tetanus and Diphtheria Toxoids" (Archives 1983;40:56-57). In our article, we described a young man in whom polyradiculoneuritis developed three days after immunization with tetanus and diphtheria toxoids. We stated that, to our knowledge, neurologic complications to tetanus and diphtheria toxoids had not been previously reported. Dr Fenichel described two cases,^1,2 purportedly complications of tetanus and diphtheria toxoids; one¹ occurred after diphtheria, tetanus, and polio immunization, and the other,² after diphtheria toxoid alone.Dr Fenichel's major objection to our article appeared to be his incorrect presumption that the symptoms of polyradiculoneuritis occurred within hours of the toxoid injection, when, in fact, it was three days later, as stated in the case summary. In a report₃ describing 22 cases of mononeuritis and polyneuritis after tetanus