Tetanus is a life-threatening infection that is rare in the developed country. Because of the rarity: of the disease, the clinician may be unfamiliar with the clinical presentation and unsuspecting of the diagnosis. However, tetanus can rapidly progress into lethal muscle spasms accompanied by respiratory insufficiency, and it has a mortality of 15 to 30%. The most common presenting symptom was trismus, followed by neck pain, dysphagia, generalized pain and facial muscle contractions. Dysphagia is a common symptom of tetanus, but not common as an initial symptom, the correct diagnosis and adequate therapy are likely to be delayed. Treatment involves administration of penicillin, tetanus immune-globulin, debridement of wounds, aggressive supportive care, and initiation of active immunization. We report an elderly woman presenting with dysphagia as an initial symptom of tetanus with review of literature.