2022 Volume 29 Issue 5 Pages 519-522
Infant botulism is a disease characterized by generalized neurological paralysis due to botulinum toxin. Its symptoms are similar to those of intracranial diseases such as cerebral nerve palsy and respiratory impairment, and we rarely encounter and may overlook it in severe or atypical cases. We present the case of a 7-month-old girl who was referred to our hospital with chief complaints of fever and lethargy. On arrival, she had coma-like symptoms with almost no response to stimulation and frequent apnea. Since the electroencephalography (EEG) showed slow waves and the norovirus antigen test was positive, we initially diagnosed her condition as acute encephalopathy. Consequently, we provided nervous system-directed intensive care, including steroid pulse therapy. The head MRI and cerebrospinal fluid test showed no abnormalities, while the EEG showed diurnal variation and response to stimulation, suggesting neuromuscular junction disease. Based on the detection of botulinum toxin in a mouse assay of her blood and stool, we diagnosed the patient with infant botulism. Tracheostomy was performed, and she was weaned from the ventilator approximately one month later. These results suggest that we should consider infant botulism when infants present with coma-like symptoms or unexplained symptoms of cerebral nerve palsy.
