Thanks to Alison for presenting the case of a middle aged man who presented with acute onset of ptosis, dysphagia, and dysarthria, with an evolving exam found to have botulism secondary to IV injection of black tar heroin.
- Botulism is extremely rare! Only 110 cases were reported last year in the US with 70-75% of them being related to infant botulism, 20-25% foodborne, and 5-10% wound botulism. The latter category has been on the rise especially in California.
- Most common form of botulism is infant botulism
- Botulism presents with bulbar symptoms; progressive, descending paralysis; absent reflexes; and autonomic dysfunction
- Management involves the following
- Notify the Department of Public Health ASAP if botulism is on your ddx
- Obtain wound/blood cultures (special tube to be sent to DPH)
- Administer antitoxin EARLY (do NOT wait for culture confirmation)
For more information, check this prior post on our blog.