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[Descending paralysis caused by wound botulism. A case report]
L P Hiersemenzel1, M Jermann, W Waespe
1Schweizer Paraplegikerzentrum, Universitätsklinik Balgrist, Zürich.
Der Nervenarzt
|March 7, 2000
Summary
This study details a case of wound botulism in an injecting drug user, characterized by descending paralysis. The rare condition, caused by Clostridium botulinum, is linked to contaminated heroin injections.
Area of Science:
- Infectious Diseases
- Neurology
- Toxicology
Background:
- Wound botulism is a rare neuroparalytic illness caused by toxins from Clostridium botulinum.
- Intravenous drug abuse is an emerging risk factor for wound botulism.
- Previous cases have been reported in Switzerland since 1997.
Observation:
- A patient presenting with multiple deep abscesses in the extremities was diagnosed with wound botulism.
- Clinical presentation included rapidly progressing descending paralysis originating from cranial nerves.
- Neurophysiologic testing revealed a neuromuscular junction disorder, with normal cerebrospinal fluid.
Findings:
- The diagnosis was confirmed based on clinical presentation, neurophysiology, and exclusion of other causes.
- Subcutaneous injection of contaminated heroin containing Clostridium spores is suspected as the route of infection.
- This case highlights the potential for wound botulism in the i.v. drug abuse population.
Implications:
- Wound botulism should be considered in the differential diagnosis of descending paralysis in i.v. drug users.
- Early recognition and treatment are crucial for managing this rare but serious condition.
- Public health awareness regarding the risks associated with contaminated drug injections is warranted.