Wound botulism in an injection drug user
A 32-year-old female injection-drug user presented with abscesses on
both forearms, complaints of progressive limb-weakness, difficulty
speaking, swallowing and shortness of breath over the last few
hours. On neurological examination she showed dysphonia and
dysarthria, partial ptosis, dyspnoea and generalised weakness with
diminished reflexes. Sensory and cognitive functions were
preserved.Within hours the patient required mechanical ventilation.
Blood count and biochemical profile, spinal fluid examination as
well as computed tomography revealed no abnormalities. Due to the
presentation wound botulism was suspected and antitoxin was
administered within 12 hours of admission.Swab samples taken during
wound debridement later confirmed Clostridium botulinum.
Furthermore, the mice inoculated with the patient’s serum
showed signs of botulism.
Neurophysiological studies on day three showed normal sensory responses,compound muscle action potential amplitudes (CMAP) were reduced with normal latencies and conduction velocity. On repetitive nerve stimulation with 30 Hz (RNS) an increment of 50%
Wound botulism should be suspected in a patient with acute descending paralysis, with involvement of autonomic and cranial nerves, especially in injecting drug users. In 2004 only 2 cases of wound botulism were reported to the Swiss Federal Office of Public Health (BAG).
|keywords||botulism, drug user|
|citation||Müller S, Tettenborn B, & Bönig L (2005). Wound botulism in an injection drug user. Presented at 176. Tagung der Schweizerischen Neurologischen Gesellschaft (St. Gallen).|
|date of publishing||27-10-2005|
|event||176. Tagung der Schweizerischen Neurologischen Gesellschaft (St. Gallen)|
|PubMed||Schweizer Archiv für Neurologie und Psychiatrie · 2005;156(07):371-391|