The incidence of wound botulism is increasing and the epidemiology of
the disease is changing. The majority of new cases are associated with
injection drug use, in particular, the use of Mexican black tar heroi
n. This case report and discussion of wound botulism illustrate the fo
llowing important points: Dysphagia, dysphonia, diplopia, and descendi
ng paralysis, in association with injection drug use, should alert the
treating physician to the possibility of wound botulism, In such pati
ents, the onset of respiratory failure may be sudden and without clini
cally obvious signs of respiratory weakness. For the reported patient,
maximum inspiratory force measurements were the only reliable indicat
or of respiratory muscle weakness, This is a measurement not routinely
performed in the ED, but may prove essential for patients with suspec
ted wound botulism. To minimize the effect of the botulinum toxin and
to decrease length of hospital stay, antitoxin administration and surg
ical wound debridement should be performed early.