26/06/2025
🦠Skin (wound) botulism is a life-threatening condition seen in people who inject drugs, especially black tar he**in. Clostridium botulinum spores contaminate injection sites and thrive in anaerobic conditions, releasing a neurotoxin that causes progressive, symmetric descending paralysis—starting with cranial nerves (ptosis, diplopia, dysarthria, dysphagia) and potentially leading to respiratory failure. Sensorium remains intact, and there’s usually no fever or sensory deficit. It should be suspected in IV drug users presenting with neurologic symptoms and infected injection sites. Treatment includes immediate administration of botulinum antitoxin, wound debridement, and antibiotics.