Wound botulism presenting as dysphagia to an ENT ward

Area of Science:

• Neurology
• Infectious Diseases
• Toxicology

Background:

• Heroin injection drug use is a known risk factor for various infections and complications.
• Botulism, a neuroparalytic illness, is typically associated with contaminated food, but wound botulism can occur from injection sites.

Observation:

• A 44-year-old man with a history of heroin injection presented with sore throat and dysphagia, progressing to rapid bulbar and descending weakness.
• The patient required intubation and intensive care, and was treated with botulinum antitoxin.
• Postmortem examination revealed heroin intoxication as the cause of death, but Clostridium botulinum neurotoxin B was confirmed at the injection site.

Findings:

• The case confirmed wound botulism in an injection drug user, evidenced by Clostridium botulinum neurotoxin B at the injection site.
• Wound botulism presented with progressive neuromuscular weakness, distinct from typical signs of localized or systemic infection seen in other injection-related complications.
• The patient's death was attributed to heroin intoxication, highlighting the complex interplay of substance use and infectious complications.

Implications:

• This case underscores the critical need to consider wound botulism in injection drug users presenting with neurological deficits, especially cranial nerve palsies.
• Differentiating wound botulism from other bacterial complications of injection drug use is important, as botulism may lack overt signs of infection.
• Raising awareness among healthcare providers about wound botulism in this population can improve diagnostic accuracy and patient outcomes.