Shot by a Gun … Missed by a Provider.

Area of Science:

• Neurology
• Infectious Diseases
• Toxicology

Background:

• Botulism is a paralytic illness caused by Clostridium botulinum neurotoxin.
• Most cases result from ingestion or injection drug use.
• Wound botulism, historically rare, is now the leading cause of adult botulism in the US.

Observation:

• A 27-year-old man with a gunshot wound developed diplopia, dysphagia, and progressive weakness.
• Despite a seemingly healing wound, wound botulism was suspected.
• The patient required mechanical ventilation due to respiratory insufficiency.

Findings:

• Rapid administration of equine heptavalent botulinum antitoxin led to significant strength recovery within 4 days.
• Serum analysis confirmed botulinum neurotoxin type A.
• Wound botulism should be considered in patients with neuromuscular symptoms and recent trauma.

Implications:

• Emergency physicians must maintain a high index of suspicion for wound botulism in patients with neuromuscular compromise and recent injuries.
• Prompt diagnosis and treatment with antitoxin are critical for favorable outcomes.
• This case highlights the evolving epidemiology of botulism in the United States.