Effective and rapid treatment of wound botulism, a case report

Abstract

BackgroundThe latest news shows several cases of contaminated heroin that is found in different parts all over Europe. This information can be helpful for the emergency doctors to find the correct diagnosis of wound botulism in patients who are intravenous drug users.Case presentationWe describe a case of a 40-year-old man who presented to the emergency department in 2016. He suffered from mild dysarthria, diplopia, dysphagia and ptosis since two days. The CT-scan of the cerebrum and the liquor were without any pathological results. We found out that the patient is an intravenous drug user and the clinical examination showed an abscess in the left groin. So we treated him with the suspected diagnosis of wound botulism.In the emergency operation we split the abscess, made a radical debridement and complementary treated him with a high dose of penicillin g and two units of botulism antitoxin. The suspected diagnosis was confirmed a few days later by finding the Toxin B in the abscess and in the patient’s serum. In the following days the neurological symptoms decreased and the wound healing was without any complications. The patient left the hospital after nine days; the antibiotic therapy with penicillin g was continued for several days. In a following examination, 14 days after the patient’s discharge of the hospital, no further symptoms were found and the abscess was treated successfully without any problems.ConclusionBecause wound botulism is a very rare disease it can be challenging to the attending physician. This case shows a fast treatment with full recovery of the patient without any further disabilities, which can be used for the future.

Botulism in the Brazilian Amazon: a life-threatening disease in a neglected population

“…Most of the previous reports of such conditions are directly related to exposure to contaminated heroin with the spores of C. botulinum . 14 In a recently published case, multiple cutaneous abscesses were present, the suspicion established through a single fiber examination. 15…”

Wound Botulism in Black Tar Heroin Injecting Users: A Case Series

“… 7 Wound botulism is the fifth most common form of botulism after foodborne, childhood, enteric infectious, and inhaled botulism. 8 In wound botulism, BoNT enters the bloodstream and targets the SNARE polypeptide complex (SNAP-25, VAMP, or syntaxin). SNARE proteins are required for fusion of ACh-containing vesicles with the presynaptic membrane.…”

Clinical cases of atypical and severe botulism

“…The most common symptoms are dysphagia (48-66 %), proximal muscle weakness of upper and lower extremities (60-73 %), neck flexor muscle weakness (33 %), ophthalmoplegia (mydriasis, anisocoria, absence or sluggish reaction to light, convergence insufficiency) (53 %), bilateral ptosis (46 %), dysarthria (53-76 %), diplopia (32-40 %), blurred vision (33-40 %), and mouth dryness (20 %). In patients with documented wound botulism, the pupils were reactive in 46 % [2,13,14]. Dizziness, rapid fatigability, nausea are also common for foodborne botulism [11].…”

“…Foodborne botulism, attributed to A, B, or E toxin, is most frequently found in Ukraine. More often there is foodborne botulism, but wound (in injecting drug users and newborns) [1][2][3], iatrogenic (when applying botulotoxin for cosmetic procedures, treatment of muscle contracture or endoscopic administration in achalasia) [4,5] and inhalation botulism [1] are also reported. Botulinum neurotoxins can be used as biological weapons [1,2].…”