In a case study in PLoS Medicine, doctors report on the case of a 35 year old heroin user who came to the accident and emergency department with double vision, slurred speech, drooping eyelids, and eye muscle weakness. The diagnosis turned out to be wound botulism.
Wound botulism is a potentially fatal illness that occurs when spores of the bacterium Clostridium botulinum contaminate a wound, germinate, and produce botulimum nerve toxin.
The doctors made the diagnosis promptly, and so were able to offer appropriate treatment, including putting the patient on a ventilator and giving him botulinum antitoxin. The patient made a full recovery.
The team of doctors who treated the man, a team by led Professor Sanjeev Krishna (St George's Hospital, University of London), says that the incidence of wound botulism following heroin injection into skin or muscle has risen dramatically in the UK since 2000. The reasons for this increase remain unclear, they say, "but may involve contamination of specific batches of heroin as well as changes in injection practices."