Dysphagia Alone as a Unique Presentation of Wound Botulism in the Emergency Department: A Case Report

Clinical Practice and Cases in Emergency Medicine
Ryan H WyattThomas E Kelly

Abstract

Wound botulism is a rare and potentially fatal infectious disease, often seen in patients who abuse injection drugs. It classically presents with dysfunction of bilateral cranial nerves followed by proximal and distal motor weakness, which can progress to respiratory failure. We report a case of a 31-year-old female who presented to the emergency department for the fifth time with an eight-day history of isolated dysphagia without any other neurologic symptoms. She reported a history of injection drug abuse via "skin popping," was admitted to the hospital, and ultimately diagnosed with wound botulism. This case exemplifies the diagnostic pitfalls of rare diseases such as wound botulism and provides insight regarding the diagnosis and treatment of this entity. This case also highlights the unique medical and social challenges emergency physicians face while trying to reliably evaluate patients who abuse controlled substances.

References

Sep 16, 2005·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Jeremy Sobel
Jan 1, 2015·The Botulinum Journal·Kelly A JacksonRyan P Fagan
Jan 3, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Kevin Chatham-StephensDana Meaney-Delman
Jan 4, 2019·MMWR. Morbidity and Mortality Weekly Report·Corey M PeakEric McDonald

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Botulism (ASM)

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium clostridium botulinum. Discover the latest research on botulism here.

Botulism

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium clostridium botulinum. Discover the latest research on botulism here.

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