A 78-year-old Hispanic male, a resident of Mexico, presented to the emergency department (ED) of a level I county trauma center with a complaint of jaw pain for the prior three days. On review of systems, the patient also complained of abdominal bloating. His medical history was only significant for hypertension, although he did not take any medications. The patient did not report having allergies, and he denied the use of tobacco, alcohol, or drugs. His vital signs were as follows: temperature 36.9° Celsius, blood pressure 165/109 millimeters of mercury, pulse 88 beats per minute, and respiratory rate 18 breaths per minute. The patient appeared to have difficulty opening his mouth and exhibited dysphonia as a result. He had no reproducible pain on exam, but was uncomfortable when we attempted to open his mouth by force. While the oral exam was limited secondary to poor mouth opening, no caries or abscesses were appreciated. No lymph nodes were palpable and the remainder of the ear, nose, and throat exam was unremarkable. The patient’s abdomen was rigid and mildly distended, but non-tender. On examination, the medial aspect of the right forearm revealed a healing laceration, approximately 5 × 2 centimeters. When questioned about the wound, the patient stated he had received it at work two weeks prior when he fell off a tractor and into muddy water. He stated he had been seen by a doctor in Mexico for the wound and was given a topical medication, which he had been applying. When asked about immunization status the patient stated that as far as he could remember he had never received any childhood or adult vaccinations. What would you consider to be a likely diagnosis given this information? What would be an appropriate treatment?