Tetanus remains a significant public health concern in low- and middle-income countries (LMICs), particularly among adults with incomplete immunization. This case report describes a 40-year-old male farmer from rural India who developed generalized tetanus following a puncture wound to the foot. Classical clinical features including trismus, generalized muscle spasms, and signs of autonomic dysfunction were present. The patient was managed in the intensive care unit with continuous intravenous magnesium sulphate (MgSO4) infusion at 1g/ hour, alongside supportive care and antibiotics. Notably, mechanical ventilation and sedative agents were not required throughout the hospital stay. Progressive improvement in muscle rigidity and spasms was observed by day two of treatment, and the patient was discharged after three weeks without complications. This case highlights the efficacy of magnesium sulphate as a neuromuscular depressant and autonomic stabilizer in moderate to severe tetanus. It underscores its potential to reduce the need for invasive ventilation, especially in resource-limited settings, and supports its use as a safe and cost-effective adjunct in tetanus management.