Opiate withdrawal and botulism: stigma delayed treatment

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7393.822/a (Published 12 April 2003) Cite this as: BMJ 2003;326:822
  1. Karl Marlowe, specialist registrar (karlmarlowe@doctors.org.uk)
  1. South London and Maudsley NHS Trust, London SW9 9HG

    EDITOR—Merrison et al reported a difficult diagnostic case of wound botulism, which led to the formulation of a helpful diagnostic table for distinguishing clinical features from Guillain-Barré syndrome, Miller-Fisher variant, and myasthenia gravis.1 I report a case of wound botulism in a long term heroin user showing that a history of substance misuse can cloud the picture even more than the clinical presentation.

    A man with a 20 …

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