[The clinical diagnosis 'wound botulism' in an injecting drug addict]

Abstract

A 38-year-old subcutaneous injecting heroin addict had subacute blurred vision, dysarthria and dysphagia. The next day she could not swallow or speak and developed weakness of all limbs and respiratory failure. Electromyography showed abnormalities compatible with a presynaptic neuromuscular transmission deficit, which supported the diagnosis of botulism. The point of entry was probably a skin abscess due to injections. Treatment with antitoxin and antibiotics resulted in a favourable recovery. Wound botulism is caused by local production of toxin by Clostridium botulinum after wound infection. Although it is a rare variant of botulism, it is increasingly being reported in drug users who inject subcutaneously.