Black Tar Heroin Skin Popping as a Cause of Wound Botulism

Abstract

In our patients, BTH injection, involving the action of injecting under the skin acetylated morphine derivatives (mostly 6-monoacetylmorphine and 3-monoacetylmorphine), was associated with the development of botulism. The availability of BTH at the US-Mexican border is not surprising since it is frequently produced in Latin America. Its association with the development of botulism should be recognized early to allow a prompt diagnosis and treatment with the antitoxin. A clinical feature worth noting is the presence of normal pupillary light reflex in nearly half of patients. Therefore, the presence of a normal pupillary response does not exclude the presence of wound botulism.

Bulbar Muscle Weakness in the Setting of Therapeutic Botulinum Injections

“… 5 The estimated human median lethal dose (LD 50 ) is 1.3–2.1 nanogram/kilogram (ng/kg) intravenously (IV) or intramuscularly (IM), 10–13 ng/kg inhaled, and 1 ng/kg oral. 6 , 7 Given this, the probability that the EP will encounter adverse effects from its use continues to rise.…”

Multiple ulcerations and devastating scars of skin popping on thighs in a middle‐aged woman

“…It may represent various acute and chronic, cutaneous, and extracutaneous complications. Bacterial infections are the most common acute cutaneous complications of skin popping and clinical presentation may vary from subcutaneous abscesses, leg ulcers, and cellulitis to life‐threatening conditions such as osteomyelitis, necrotizing fasciitis, wound botulism, and sepsis/myonecrosis syndrome 5‐7 . The impaired skin barrier allows easy inoculation of microorganisms and irritants into the skin that result in the formation of superficial or deep suppurative infections.…”

“…4 Skin popping is an underdiagnosed skin manifestation of drug abuse that may be easily misdiagnosed by clinicians especially for ing fasciitis, wound botulism, and sepsis/myonecrosis syndrome. [5][6][7] The impaired skin barrier allows easy inoculation of microorganisms and irritants into the skin that result in the formation of superficial or deep suppurative infections.…”

Is black tar heroin use associated with wound botulism? A report of two Hispanic patients

“…As wound botulism is a potentially lethal condition caused by clostridium botulinum (anaerobic gram-positive bacterium, which produces a neurotoxin that causes paralysis), early recognition and prompt treatment can decrease the overall mortality, total length of hospital stay and thus reduces the financial burden on the health-care systems. 2…”