Scenario: 25 year old patient presented to the emergency room with complaint of 2 days history of muscular weakness which is symmetric and descending and diplopia. He denies any fever or chills. He does give the history of having injury to the face. He works as marine driller. His symptoms are progressively getting worse. His vitals signs reveal no fever, and bradycardia with the heart rate of 48 and blood pressure of 120/80 mm hg. His Slow vital capacity was 1 liter (33% of predicted). He was admitted in intensive care unit.


Diagnosis: Botulism (110 cases in US per year with 3 percent being wound Botulism)

Differential diagnosis: Mysthenia Gravis, Lambert-Eaton syndrome, Guillain-Barre’s syndrome, poliolmyelitis, Ticks paralysis, heavy metal intoxication.

Botulism has an acute onset with bilateral cranial neuropathies and symmetric descending weakness. Key feature include:

•Patient is afebrile
•Symmetric neurological deficit
•Patient is responsive
•Normal or slow heart rate and normal blood pressure
•No sensory deficit
•Blurred vision

Treatment:

•Equine serum botulism antitoxin
•Penicillin G intravenously 3 grams every 4 hours