Wound botulism presenting as a deep neck space infection.
Otolaryngologists commonly evaluate patients with findings suspicious for deep space soft tissue infections of the neck. In this case, a woman with a history of injection drug use (IDU) presented with dysphagia, odynophagia, and neck pain. Multiple neck abscesses, too small to drain, were seen on imaging. Despite broad-spectrum intravenous antibiotics, she unexpectedly and rapidly developed respiratory failure requiring intubation. Further work-up diagnosed wound botulism (WB). To our knowledge, this is the first report of WB presenting as a deep neck space infection, and illustrates the importance of considering this deadly diagnosis in patients with IDU history and bulbar symptoms.
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California 94115, USA.
Christopher
C
Gouveia
Somnath
S
Mookherjee
Matthew S
MS
Russell
D000038:Abscess / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001906:Botulism / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D003014:Clostridium botulinum / Q000302:isolation & purification*; D003937:Diagnosis, Differential; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D009333:Neck; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents