Abstract

Introduction: Wound botulism is a rare but potentially life-threatening neuroparalytic syndrome resulting from a neurotoxin elaborated by the bacterium Clostridium botilinum. No cases were reported in the UK prior to 2000, to date around 150 cases have been confirmed in injecting drug users.

Case presentation: In January 2015, an intravenous drug user presented with a 48-hour history of progressive blurred vision, diplopia, aphonia, dysphagia with evidence of type 2 respiratory failure. The patient could only communicate by writing and within two hours of hospital admission there was marked deterioration in condition with a progression of symmetrical descending paralysis necessitatinginvasive ventilation. Wound botulism secondary to infection with Clostridium botilinum producing toxin serotype B was confirmed.

Conclusion: There has been a cluster of cases of wound botulism in injecting heroin users in the West of Scotland. Recovery from the disease is slow with a high morbidity and mortality rate.

Keywords: Wound botulism; Intravenous drug user; Clostridium botilinum