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Arch Dermatol. 2003;139:1661-1662.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

DURING AUGUST 22-26, 2003, four injection-drug users (IDUs) in Yakima County, Washington, sought medical care at the same hospital with complaints of several days of weakness, drooping eyelids, blurred vision, and difficulty speaking and swallowing. All four were regular, nonintravenous injectors of black tar heroin (BTH), and one also snorted BTH. This report summarizes the investigation of these cases, which implicated wound botulism (WB) as the cause of illness.

Of the four patients, two were men; the patients had a median age of 38 years (range: 31-50 years). Two patients were married and used drugs at the same time and in the same setting as the third patient; however, they did not share injection equipment with the third patient. The fourth patient had no social connection with the other three. All four purchased BTH from the same dealer. No meals or gatherings were attended by all of the patients, and . . . [Full Text of this Article]

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