Wound Botulism Complicating a Snake Bite Wound Following Traditional Application of Raw Goat Skin Successfully Treated with Botulinum Antitoxin: A Case Report

Ahmad Shekaib Rasikh,1 Mohammad Maroof Aram,2 Abdul Tawab Noory,1 Aminulhaq Sarwary1 1Department of Infectious Diseases, Ali Abad Teaching Hospital, Kabul University of Medical Sciences, Kabul, Afghanistan; 2Department of Internal Medicine, Ali Abad Teaching Hospital, Kabul University of Medical Sciences, Kabul, AfghanistanCorrespondence: Ahmad Shekaib Rasikh, Email [email protected]: Wound botulism is a rare, life-threatening neuroparalytic disease caused by neurotoxins produced by Clostridium botulinum in contaminated wounds. Traditional wound care practices, such as applying animal products, may increase the risk. We report the case of a 35-year-old woman from Afghanistan who presented with progressive descending neurological deficits, including bilateral ptosis, blurred vision, diplopia, nasal speech, dysphagia, and respiratory distress. Symptoms began nine months after a snake bite to the left lower leg that evolved into chronic non-healing calf ulcers. Traditional treatment involved direct application of raw goat skin obtained from a slaughterhouse, likely introducing C. botulinum spores into the wound. Clinical findings supported a diagnosis of wound botulism, although microbiological confirmation was unavailable due to resource limitations. Botulinum antitoxin, procured with delay through the World Health Organization, led to the patient’s near-complete recovery.Keywords: wound botulism, snake bite, raw goat skin, botulinum antitoxin