שאלה משלב א׳ במחלות עור ומין · מועד 2022, שאלה 65

Blurred vision, ptosis and facial nerve weakness with local pain in a drug user, and no fever or leucocytosis, is WOUND BOTULISM from CLOSTRIDIUM BOTULINUM TYPE A - classically associated with injected black tar heroin and cocaine use - presenting with descending cranial nerve palsies, diplopia, dysphagia and the threat of respiratory failure. Treatment is antitoxin, wound debridement, penicillin and respiratory support; the bacterial infections listed would cause local infection with fever rather than cranial neuropathy.

מקור: Bolognia p. 2385-2388