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Five days after sustaining a compound fracture of his right arm, this 14-year-old boy noticed that he had blurred vision. Fourdays later, he could not swallow, move his lips, or protrude his tongue. Other findings included bilateral total ophthalmoplegia with ptosis (left) anddilated, fixed pupils (right). His mental status and sensory examination were normal.
When symmetric, descending cranial nerve paralysis develops four to 14 days after an open injury and spares mental and sensoryfunction, think of wound botulism. In this patient, culture of serosanguineous fluid from the fracture site grew Clostridium botulinum .
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