Wound botulism has been identified as a risk of parenteral cocaine abuse (1-3). We report a case of botulism associated with maxillary sinusitis after intranasal cocaine abuse; Clostridium botulinum was subsequently cultured from the maxillary sinus.
A 25-year-old obese man developed headache, diplopia, and disequilibrium one day before admission, followed by dysphonia, dysarthria, dysphagia, increasing weakness, and ataxia. There was a 7-day history of rhinorrhea and sore throat. He had used intranasal cocaine only twice, most recently 10 days earlier, at which time he used one eighth of a gram of cocaine. The cocaine and all food eaten during the