Li Lucy Qian, Cadamy Andrew, Seaton Andrew
Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, UK
Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, UK.
BMJ Case Rep. 2020 Feb 11;13(2):e232367. doi: 10.1136/bcr-2019-232367.
A 44-year-old man with a background of heroin injection drug use was referred to the ear, nose and throat team with a sore throat and dysphagia. He was treated with intravenous antibiotics and steroids for suspected uvulitis. He developed progressive bulbar weakness and symmetrical descending weakness of the upper extremities over a 12-hour period and was intubated prior to transfer to the intensive care unit.Botulinum heptavalent antitoxin was administered, and subsequent PCR assay confirmed neurotoxin B from his most recent injection site. He was found unconscious on the ward 3 days following extubation. Postmortem confirmed he died from heroin intoxication.This case highlights the importance of considering wound botulism in injection drug users presenting with unexplained weakness, particularly of the lower cranial nerves. Botulism is not characteristically associated with signs of localised or systemic infection in contrary to other bacterial complications of injection drug use.
一名有海洛因注射吸毒史的44岁男子因咽痛和吞咽困难被转诊至耳鼻喉科团队。他因疑似悬雍垂炎接受了静脉抗生素和类固醇治疗。在12小时内，他出现了进行性延髓肌无力和上肢对称性下行性肌无力，并在转至重症监护病房之前进行了插管。给予了七价肉毒杆菌抗毒素，随后的聚合酶链反应检测从他最近的注射部位证实了神经毒素B。拔管3天后，他在病房被发现昏迷。尸检证实他死于海洛因中毒。该病例强调了在出现不明原因肌无力（尤其是下颅神经肌无力）的注射吸毒者中考虑伤口型肉毒中毒的重要性。与注射吸毒的其他细菌并发症不同，肉毒中毒通常与局部或全身感染的体征无关。
