SHM Converge Scientific Abstract ePoster Gallery-A Spore-Adic Case of Botulism

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This case describes a 26-day-old full-term infant girl who was transferred for persistent feeding intolerance, hypotonia, and acute respiratory failure. She initially presented after four days of worsening feeding difficulty, lethargy, and dyspnea, with normal stools and no known toxin exposure or trauma. Because her neurologic and respiratory symptoms were broad and intermittent, the early differential focused on genetic, neuromuscular, metabolic, infectious, and toxic causes.<br /><br />On examination, she was non-toxic but had hypertension, tachycardia, sluggishly reactive pupils, bilateral ptosis, diffuse hypotonia, weak suck and Moro reflexes, hypophonic cry, and preserved deep tendon reflexes. Her respiratory course fluctuated, requiring CPAP and later more intensive support. Testing for hypothyroidism, chromosomal disorders, sepsis, encephalitis, inborn errors of metabolism, mitochondrial disease, neuromuscular disorders, and neonatal myasthenia gravis was unrevealing. Head and pyloric ultrasounds, echocardiogram, and EEG were normal. MRI showed small areas of white matter injury, but this did not explain the full syndrome.<br /><br />Flexible laryngoscopy showed absent supraglottic and hypopharyngeal sensation, pooling secretions, and abnormal swallow coordination, which raised concern for a bulbar process. Only after several days of an inconclusive work-up was botulism testing obtained. Stool testing later returned positive for Clostridium botulinum type A, confirming infant botulism. BabyBIG was administered the following day.<br /><br />The key lesson is that infant botulism should remain on the differential for infants with hypotonia, feeding difficulty, ptosis, weak cry, and respiratory failure even when constipation or a clear exposure history is absent. Because treatment is most effective when given within the first three hospital days, diagnosis should not be delayed while waiting for confirmatory testing. The patient ultimately had full recovery with ongoing physical and speech therapy.

Asset Subtitle

Lubna S. Hashim

Meta Tag

Author List Alina G. Burek, Lubna S. Hashim, Mary Claire Potter, Megan G. LaCroix

Category Clinical Vignettes

Concept Infant Botulism

Concept Hypotonia

Concept Feeding Difficulty

Concept Bulbar Dysfunction

Concept Respiratory Compromise

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin and Affiliated Hospitals

Presenting Author Lubna S. Hashim

Track Pediatric

Keywords

infant botulism

Clostridium botulinum type A

hypotonia

feeding intolerance

respiratory failure

ptosis

weak cry

bulbar dysfunction

BabyBIG

neonatal neuromuscular disorder

Infant Botulism

Hypotonia

Feeding Difficulty

Bulbar Dysfunction

Respiratory Compromise