Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot#634, Little Rock, AR 72205, USA.
Dysphagia. 2011 Sep;26(3):337-9. doi: 10.1007/s00455-010-9300-6. Epub 2010 Aug 31.
Wound botulism is exceedingly rare and occurs almost exclusively among injection drug users. In 2008 there was a case of wound botulism in a noninjecting drug user reported to the Centers for Disease Control and Prevention (CDC). We report a case of a Caucasian male developing dysphagia due to wound botulism after having a motorcycle accident that left him with open fractures. The CDC was contacted and the patient was transferred to medical intensive care unit to be emergently started on hepatavalent Clostridium botulinum antitoxin. Early suspicion of wound botulism is essential for effective therapy with antitoxin in this life-threatening disease. If not suspected, this patient would likely have died. Nevertheless, the delay in diagnosis and treatment resulted in the patient's suffering dysphagia and neurological deficits. The patient required a percutaneous endoscopic gastrostomy tube and months of dysphagia therapy, supportive care, and rehabilitation. Our aim is to increase the awareness for wound botulism when a patient presents with dysphagia and diplopia after suffering open wounds. If suspected early, the morbidity and mortality from this disease can be prevented.
创伤性肉毒中毒极为罕见，几乎仅发生于注射吸毒者。2008 年，美国疾病控制与预防中心（CDC）曾报告过一例非注射吸毒者的创伤性肉毒中毒病例。我们报告了一例白人男性因摩托车事故导致开放性骨折而出现吞咽困难的病例，该患者诊断为创伤性肉毒中毒。CDC 接到报告后，将患者转至医疗重症监护病房，紧急使用抗肉毒梭菌血清进行治疗。早期怀疑创伤性肉毒中毒对于这种危及生命的疾病采用抗毒素进行有效治疗至关重要。如果没有怀疑，该患者可能已经死亡。然而，诊断和治疗的延迟导致患者出现吞咽困难和神经功能缺损。患者需要进行经皮内镜胃造口术，并接受数月的吞咽困难治疗、支持性护理和康复治疗。我们的目的是提高对创伤性肉毒中毒的认识，当患者在遭受开放性伤口后出现吞咽困难和复视时，应考虑这种疾病。如果早期怀疑，可预防该疾病的发病率和死亡率。
