A previously healthy 7-month-old child was admitted to our emergency room with a 24-hour history of poor feeding, sleepiness, and hypotonia. Main clinical signs were apyrexia, weak crying, poor head control, constipation, and a symmetrical flaccid paralysis affecting head, trunk, and limbs with normoevocable lower tendon reflexes. Patient was unable to avoid light due to ophthalmoplegia ([Video 1]). Blood and cerebrospinal fluid tests, electroencephalogram, and central nervous system (CNS) magnetic resonance imaging were unremarkable, excluding sepsis, encephalitis, inborn errors of metabolism, spinal muscular atrophy, and inflammatory diseases of the CNS.[1] The patient developed progressive respiratory failure within hours and required mechanical ventilation. The suspicion of botulism was confirmed by stool detection of Clostridium botulinum toxin subtype A. Parents denied the administration of honey; the father is a construction worker, so we believe the spores were brought home by the construction site dust.

Video 1 The video shows ophthalmoplegia with inability to avoid light and fixed mydriasis suggesting brain stem involvement.

Clinical diagnosis remains the cornerstone for detecting botulism and maintaining high clinical suspicion is the key to prompt clinical management; therefore, early recognition and scrupulous supportive care are required for complete recovery.[2] [3]

Received: 25 January 2022

Accepted: 05 May 2022

Article published online:
28 August 2022

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