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Neurological rarities
Delayed onset post-traumatic wound botulism
  1. Mai Elrayes1,
  2. Sarah Al Bachari1,
  3. Ronan Macdonagh2,
  4. Alex Peel3,
  5. Salman Khurshid3,
  6. Juiliana Hamzah4,
  7. Tim Holzmann4,
  8. Amina Chaouch1,
  9. Gemma Cummins1,
  10. David McKee1,
  11. Anna Richardson1,
  12. Christopher Kobylecki1
  1. 1Neurology Department, Manchester Centre for Clinical Neuroscience, Northern Care Alliance NHS Foundation Trust, Salford, UK
  2. 2Neurophysiology Department, Manchester Centre for Clinical Neuroscience, Northern Care Alliance NHS Foundation Trust, Salford, UK
  3. 3Microbiology Department, Northern Care Alliance NHS Foundation Trust, Salford, UK
  4. 4Critical Care Unit, Northern Care Alliance NHS Foundation Trust, Salford, UK
  1. Correspondence to Dr Mai Elrayes, Neurology department, Manchester centre for clinical neuroscience, Northern Care Alliance NHS Foundation Trust, Manchester, M6 8HD, UK; mai.elrayes{at}nca.nhs.uk

Abstract

A 41-year-old man developed rapidly progressive cranial neuropathies and muscle weakness followed by respiratory failure, requiring ventilation support. On examination, there was marked bilateral ptosis and ophthalmoplegia with bulbar, neck and proximal upper limb weakness. He had a recent open left humeral fracture that eventually required amputation. Despite immunoglobulin therapy, his progressive weakness continued. Multiple investigation results were inconclusive. Eventually, botulinum type A toxin was found positive, by which time the therapeutic window for antitoxin had passed. He continued on supportive management and was treated for concomitant infections and nosocomial illnesses. He was subsequently weaned from respiratory support and has made a good neurological recovery.

  • BOTULINUM TOXIN
  • NEUROPATHY
  • RESPIRATORY MEDICINE
  • NEUROMUSCULAR

Data availability statement

No data are available.

https://doi.org/10.1136/pn-2023-004036

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    Data availability statement

    No data are available.

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    Footnotes

    • Contributors All authors provided clinical care for the patient. ME took the lead in writing the manuscript, gathering most data and obtaining the patient’s consent. CK provided critical revision of the manuscript. JH helped in clinical data collection. RM reviewed the neurophysiology part. AP and SK reviewed the microbiological part.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally reviewed by Jon Walters, Swansea, UK.

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