To report a case of Botulism caused by shared IV needle use in an IV drug user. 

We chart reviewed a patient who presented with dysphagia, dysphonia, ptosis and cranial nerve deficits and was found to have Botulism.

A 30 year old male with history of type 1 diabetes mellitus presented with a two day history of dysphagia, dysarthria, ptosis, facial weakness, and ophthalmoparesis. On initial presentation he did not relate any risk factors for botulism exposure. His MRI brain was unremarkable. EMG demonstrated about 100% motor amplitude increment with 10 second exercise test consistent with a presynaptic neuromuscular junction abnormality and without any other features to suggest a Guillain Barre variant.He then admitted to use of his brother’s old  IV needle that had dried blood on it for recreational drug use 2 days prior to the onset of symptoms.  We diagnosed him with acute botulism and notified CDC. He received botulism anti-toxin and was started on Penicillin G. He stabilized clinically.

Botulism is a very rare and potentially fatal disease mostly caused by ingestion of contaminated food and wound infections. However with the opioid epidemic and increased IV drug abuse with possible contamination of injected substances, it is important to consider Botulism in this patient cohort. Prompt diagnosis is important for effective treatment.