Hiroshi T. Suzuki, MD, MPH; Hari Reddy, MD
Corresponding Author: Hiroshi T. Suzuki, MD, MPH; University of California, Riverside. Email: hiroshi.suzuki@medsch.ucr.edu
Section: Brief Report
Publication Date: July 23, 2021
Introduction: Wound Botulism (WB) is an uncommon but serious neuromuscular illness caused by the bacterium Clostridium Botulinum in an infected wound. There has been a dramatic increase in WB associated with black tar heroin (BTH) injection in California. Case Description: A 50-year old male with heroin abuse presented to the Emergency Department with a 2-day history of dysphagia and dysarthria. Physical examination revealed slurred speech, inability to manipulate tongue, and slowed eye movements. Patient was also noted to have progressive weakness during hospitalization. Laboratory findings were unremarkable and further workup including CT head, and CT soft tissue neck showed no abnormal findings. Given the history of heroin abuse in Southern California and findings on physical exam, a diagnosis of WB needed to be considered as the differential. Department of Health was contacted and treatment was initiated with the Botulism Antitoxin (AT) and metronidazole. Despite the treatment, patient’s condition did not improve, and the patient passed away. Diagnosis was confirmed by C botulism toxin A in serum a few days after patient deceased. Discussion: Progressive cranial nerve palsy with symmetric descending paralysis with heroin abuse should raise the suspicion of wound botulism and require prompt diagnosis and treatment. This case highlights raising awareness of the disease could help lead to early diagnosis and treatment.