Friday, October 24, 2008


You see a 4 month old child brought in by the mother because of constipation, poor feeding, and weak cry. When you examine the child, you notice hypotonia, weakness, and loss of deep tendon reflexes. There is a decreased gag and suck, diminished range of eye movement, pupillary paralysis, and ptosis. You note decreased salivation and tearing and flushed skin. Prior to this illness, the child had been developing well; he had been able to lift his head, he had a social smile, and he was beginning to eat honey. He was never breastfed.

Challenge: What's the diagnosis?


Alex said...


Craig Chen said...


This is infant botulism from Clostridum botulinum which produces a neurotoxin that blocks presynaptic cholinergic transmission, affecting skeletal and smooth muscle as well as autonomic transmission. Infants are between one week and 12 months and the disease is associated with environmental dust with spores and ingestion of wild honey or home canned foods. The diagnosis is made clinically and confirmed by stool samples. A botulinum immune globulin can be given.

Source: UpToDate.