title: Wound botulism associated with black tar heroin and lower extremity cellulitis.
abstract: Wound botulism is a rare and potentially fatal disease. The use of black tar heroin has spawned an increase in the incidence of the disease, with the majority of cases occurring in California. The use of botulism antitoxin and surgical debridement are recommended to decrease hospital stay. For this to be effective, the diagnosis of wound botulism first must be considered, followed by an aggressive search for any area of infection that may be debrided. This case report demonstrates several factors to consider in patients presenting with symptoms of botulism poisoning: occurrence away from the Mexico border, no obvious abscess, and the need for prolonged ventilatory support. This case report documents a prolonged hospital stay, possibly caused by delay in administration of antitoxin in a patient with cellulitis that was not considered appropriate for debridement.
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado 80204-4507, USA
authors.forename: P A
authors.initials: PA
authors.lastname: Mitchell
authors.forename: P T
authors.initials: PT
authors.lastname: Pons
mesh_terms: D001906:Botulism / Q000150:complications* / Q000209:etiology*; D002481:Cellulitis / Q000150:complications*; D006556:Heroin Dependence / Q000150:complications*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012307:Risk Factors; D016896:Treatment Outcome; D014946:Wound Infection / Q000503:physiopathology*