Clostridium infection resulting in paralysis in a child

We report an 11-year-old boy who fell from an All Terrain Vehicle and sustained multiple minor soft tissue contusions and a small midthoracic laceration. Irrigation and closure of the small wound was performed at another hospital. There was no history of a penetrating wound. Within 48 h of injury, the patient developed profound dysesthesia and paralysis of the lower extremities and was transferred to our hospital. MRI disclosed a paraspinal abnormality without bony involvement. At exploration a portion of a tree branch was removed. Wound cultures were positive for Clostridium botulinum, tetani, and perfringens.

To our knowledge, this is the first case of direct Clostridium intoxication of the spinal cord in man. Moreover, this report demonstrates the invasive manner in which Clostridium toxins may breach both the intact ligamentum flavum and the dura mater to deliver their toxicity to the intradural contents. Although the patient's dysesthesia resolved and paraplegia improved to ambulation he is still left with a significant motor deficit.