, Volume 33, Issue 7, p 1301
Date: 29 Mar 2007

Diagnostic pitfall: wound botulism in an intoxicated intravenous drug abuser presenting with respiratory failure

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access
This is an excerpt from the content

Sir: Wound botulism has gained importance because of rising occurrence among injecting drug users (IDUs) in the United Kingdom and United States over the past 20 years [13] and recently also in Germany [4]. The causative organism is Clostridium botulinum, an anaerobic, gram-positive, spore-forming bacterium. We report a case of wound botulism initially misdiagnosed as drug intoxication.

A 30-year-old female IDU was admitted to the emergency department because of rapidly progressing dyspnea. She was intubated and transferred to the medical ICU. Toxicological screening revealed an intake of flunitrazepam, methadone, and cocaine, and the initial diagnosis was respiratory failure due to intoxication. A formal neurological examination of the patient, who was still ventilated on day 3, revealed high-grade flaccid tetraparesis, facial diplegia, and bilateral ptosis. Pupils were dilated and did not react to light. Eye movements were conjugate with slowed saccades and vertical gaze paralysis. T ...