Introduction: Wound botulism (WB) is an uncommon but severe neuromuscular illness caused by the bacterium Clostridium botulinum in an infected wound. There has been a dramatic increase in WB associated with black tar heroin injection in California. Case Description: A 50-year-old male with heroin abuse presented to the emergency department with a 2-day history of dysphagia and dysarthria. Physical examination revealed slurred speech, inability to manipulate tongue, and slowed eye movements. The patient was also noted to have progressive weakness during hospitalization. Laboratory findings were unremarkable, and further workup, including a computerized tomography scan of the head and soft neck tissue, showed no abnormal findings. Given the history of heroin abuse in Southern California and findings on physical examination, a diagnosis of WB needed to be considered as the differential. The Department of Health was contacted, and treatment was initiated with botulism antitoxin and metronidazole. Despite the treatment, the patient's condition did not improve, and the patient died. The resulting diagnosis was confirmed by C. botulism toxin A found in his serum a few days after the patient died. Discussion: Progressive cranial nerve palsy with symmetric descending paralysis with heroin abuse should raise the suspicion of WB and require prompt diagnosis and treatment. This case highlights raising awareness of the disease could help lead to early diagnosis and treatment.

中文翻译：

---

使用黑焦油海洛因后继发于肉毒中毒的颅神经麻痹

简介：伤口肉毒杆菌中毒 (WB) 是一种罕见但严重的神经肌肉疾病，由感染伤口中的肉毒梭菌引起。在加利福尼亚，与黑焦油海洛因注射相关的 WB 急剧增加。病例描述：一名患有海洛因滥用的 50 岁男性因吞咽困难和构音障碍 2 天就诊于急诊科。体格检查显示言语不清，无法操纵舌头，眼球运动减慢。还注意到患者在住院期间出现进行性虚弱。实验室检查结果并不显着，进一步的检查，包括对头部和颈部软组织进行计算机断层扫描，没有发现异常发现。鉴于南加州的海洛因滥用史和体检结果，需要将 WB 的诊断视为鉴别诊断。联系了卫生部，并开始使用肉毒杆菌抗毒素和甲硝唑进行治疗。尽管进行了治疗，患者的病情并没有好转，最终患者死亡。患者死亡几天后，他的血清中发现了肉毒杆菌毒素 A，从而证实了这一诊断结果。讨论：进行性颅神经麻痹伴对称性下行麻痹伴滥用海洛因应怀疑 WB 并需要及时诊断和治疗。这个案例强调了提高对该疾病的认识可能有助于早期诊断和治疗。病情未见好转，患者死亡。患者死后几天，在他的血清中发现了肉毒杆菌毒素 A，证实了这一诊断结果。讨论：进行性颅神经麻痹伴对称性下行麻痹伴滥用海洛因应怀疑 WB 并需要及时诊断和治疗。这个案例强调了提高对该疾病的认识可能有助于早期诊断和治疗。病情未见好转，患者死亡。患者死后几天，在他的血清中发现了肉毒杆菌毒素 A，证实了这一诊断结果。讨论：进行性颅神经麻痹伴对称性下行麻痹伴滥用海洛因应怀疑 WB 并需要及时诊断和治疗。这个案例强调了提高对该疾病的认识可能有助于早期诊断和治疗。