Infantile Botulism: One of the Multiple Etiologies of AcuteHypotonia in Infancy

Background and Aim : Infant botulism is an uncommon disease with a challenging diagnosiswhich is often confused with other diseases. This is a report of a case of infant botulism with nohistory of honey ingestion and responds well to equine immunoglobulin due to the low prevalenceand importance of the mentioned disease.Methods : Our patient was a ۱-year-old infant. The patient underwent a thorough evaluation andphysical examination after being transferred to our center. Further, the infant was conscious whilehe had an expressionless face and bilateral ptosis. Furthermore, his crying was weak, and theinability of controlling the neck was noted when he was in his mother’s arms. In addition, hispharynx was examined and also stool samples were sent for botulinum toxin detection.Results : Laboratory tests were normal, including complete blood count differential, erythrocytesedimentation rate, and C-reactive protein. Additionally, the analysis of cerebrospinal fluid (CSF)was normal, and CSF, along with blood and urine cultures was negative. The patient’s chestradiograph was also normal. Moreover, he had no gag reflex by examining the pharynx and, ingeneral, he suffered from hypotonia. Botulinum toxin detection was positive for C. botulinumtoxin type B. Treatment was began with equine antitoxin due to the lack of Baby-BIG in ourcountry. The initial complaints were gradually resolved after receiving two doses of equineantitoxin. Further, the patient was transferred to the pediatric ward after reducing hypotonia andimproving ptosis relatively and returning gag reflex and improving nutritional status. Finally, hewas relieved in a good general condition after about three and a half weeks of hospitalization.Conclusion : In general, a strong clinical suspicion is required for the diagnosis of infancybotulism, which should be taken into consideration in any infant who presents with constipation,poor feeding, muscle weakness, and ptosis, and then specific tests should be used to confirm thediagnosis. Eventually, specific botulinum immunoglobulin should be applied for treatment priorto laboratory confirmation.

کلیدواژه ها:

Infantile botulism ، Clostridium botulinum ، Honey ingestion