You are asked to review a 25-year-old female office worker who has presented to ENT with a sore throat and a progressive dysphagia.
She is apyrexial, haemodynamically stable and fully concious. A full examination reveals extensive wounds across her thighs due to subcutaneous heroin injection.
Her neurology continues to progress over the next 24 hours, and she develops diplopia followed by a loss of motor power in her arms. She then loses the ability to stand from sitting but has no sensory loss. She subsequently deteriorates into respiratory failure, ultimately requiring intubation and ventilation. A clinical diagnosis of botulism is made.
Written by Dr Martin Smith
First published on 24 September 2020