Wound Botulism in the Setting of Pregnancy: A Literature Review and Case Report.

Botulism is a rare neuroparalytic illness caused by Clostridium botulinum that can manifest as a descending flaccid paralysis, progressing from cranial neuropathies to respiratory failure. Wound botulism, constituting a minority of cases, is majorly associated with the injection of black tar heroin (BTH) in the western United States. A patient population of particular concern is pregnant women, who may experience a more severe course due to the physiological changes that occur in pregnancy. Because botulism in pregnancy lacks pathognomic features, physicians should maintain a high clinical suspicion when faced with a pregnant patient with neurological symptoms and a history of BTH use. Here, we report the case of a 25-year-old G3P1A1 female with a history of BTH use who presented with cranial neuropathies and respiratory insufficiency.