Objective:

Wound botulism is a rare, neuromuscular junction disease caused by the most potent neurotoxin known to humankind. Like all forms of Botulism, infection is caused by botulinum neurotoxins (BoNTs) produced by the bacteria Clostridium botulinum, most commonly type A and B. Common scenarios leading to C. botulinum infection are injection drug use (“skin-popping”) or contamination of drug material such as black tar heroin with botulinum toxin.

Background:

Our patient is a 62 year old female with Diabetes Mellitus type II, lower extremity DVT, Nicotine dependence and Intravenous methamphetamine use. 

Design/Methods:

N/A

Results:

Our patient's presentation was four days after their symptoms began. Five hours after admission the patient was started on Rocephin for concern of cellulitis of right hand and boil vs abscess on left arm. 18 hours later the patient worsened requiring intubation for NIF of 0, worsening dysarthria and inability to protect their airway. Neurologic examination worsened with the patient becoming progressively weaker and displaying flaccid paralysis with absent reflexes in their extremities. Approximately 48 hours later, the team had a discussion with the neurologist regarding concern for possible botulinum infection with patient’s history of IVDU, and flaccid paralysis. Consults were placed to infectious disease for recommendations and to general surgery for Incision and drainage of abscess on left hand and eschar on right hand. The local the health department was contacted. The health department then contacted the CDC. The patient received botulinum antitoxin approximately 36 hours after admission.

Conclusions:

This case highlights the emerging public health concern of wound botulism associated with IV drug use, including methamphetamine. Healthcare providers should maintain a high index of suspicion for wound botulism in individuals with a history of drug use paying special attention to heroin and methamphetamine use.