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A 34 year old drug misuser attended the hospital emergency department with a week-long history of progressive ptosis, dysphagia, dysphonia, and unsteady gait. Examination revealed chronic abscesses on each thigh. Her weakness progressed rapidly, and she ultimately required ventilatory support. Botulinum poisoning was diagnosed, and the patient was treated with antitoxin and intravenous antibiotics and by excision of the abscess cavities. Tissue culture confirmed the diagnosis. The patientdoi:10.1136/bmj.39248.411424.ad1 fatcat:ks4u5tu6z5ge5ahh4bdy4gqeyi