Top

Published in:

Open Access 01-12-2022 | Clostridium Botulinum | Case report

Benign food-borne type B botulism presenting as unilateral internal ophthalmoplegia: a case report

Authors: Francesco Crescenzo, Raffaele Del Colle, Domenico Ajena, Matteo Stecca, Laura Ferigo, Francesca Rossi, Michelangelo Turazzini

Published in: BMC Neurology | Issue 1/2022

Abstract

Background

Food-borne botulism is a rare neuromuscular junction disorder due to the effect of toxins released from Clostridium botulinum ingested by eating improperly stored food. Its classic manifestation is a rapidly evolving descending symmetrical flaccid paralysis with dysautonomia.

Case presentation

We have described a case of type B food-borne botulism with a benign clinical course characterized by an initially unilateral tonic mydriatic pupil. An extensive neurophysiological evaluation inclusive of pilocarpine eye drop(s) test, facial and limbs nerve stimulation and sudomotor tests, was decisively leading the diagnostic process.

Conclusions

The importance of what has been described here lies in underlining that it is always advisable to consider food-borne botulinum intoxication, even in the case of unilateral/asymmetrical internal ophthalmoplegia without generalized progressive involvement of the voluntary muscles.

Anniballi F, Auricchio B, Fiore A, Lonati D, Locatelli CA, Lista F, et al. Botulism in Italy, 1986 to 2015. Eurosurveillance. Disponibile su: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2017.22.24.30550. Accessed 09 May 2022.

Rao AK, Lin NH, Jackson KA, Mody RK, Griffin PM. Clinical characteristics and ancillary test results among patients with botulism—United States, 2002–2015. Clin Infect Dis. 2018;66(suppl_1):S4-10.CrossRef

Gdynia HJ, Huber R, Kastrup A, Riecker A. Atypical botulism sparing palsy of extraocular muscles. Eur J Med Res. 2007;12(7):300–1.PubMed

Gutmann L, Pratt L. Pathophysiologic aspects of human botulism. Arch Neurol. 1976;33(3):175–9.CrossRefPubMed

Potulska-Chromik A, Zakrzewska-Pniewska B, Szmidt-Sałkowska E, Lewandowski J, Siński M, Przyjałkowski W, et al. Long lasting dysautonomia due to botulinum toxin B poisoning: clinical- laboratory follow up and difficulties in initial diagnosis. BMC Res Notes. 2013;6(1):438.CrossRefPubMedPubMedCentral

Jenzer G, Mumenthaler M, Ludin HP, Robert F. Autonomic dysfunction in botulism B. Neurology. 1975;25:150.CrossRefPubMed

Ehrenreich H, Garner CG, Witt TN. Complete bilateral internal ophthalmoplegia as sole clinical sign of botulism: confirmation of diagnosis by single fibre electromyography. J Neurol. 1989;236:243–5.CrossRefPubMed

Monaco S, Freddi N, Francavilla E, Meneghetti F, Fenicia L, Franciosa G, et al. Transient tonic pupils in botulism type B. J Neurol Sci. 1998;156(1):96–8.CrossRefPubMed

Trivisano M, D’Orsi G, Gianmario A, Ciarallo M, Liuni ME, et al. An Asymmetric Onset of Neurological Signs Does Not Rule Out the Botulism. J Neuroinfect Dis. 2015;6:188. https://doi.org/10.4172/2314-7326.1000188.

10.

Witoonpanich R, Vichayanrat E, Tantisiriwit K, Rattanasiri S, Ingsathit A. Electrodiagnosis of botulism and clinico-electrophysiological correlation. Clin Neurophysiol. 2009;120(6):1135–8.CrossRefPubMed

11.

Oh SJ. Botulism: electrophysiological studies. Ann Neurol. 1977;1(5):481–5.CrossRefPubMed

12.

Kongsaengdao S, Samintarapanya K, Rusmeechan S, Sithinamsuwan P, Tanprawate S. Electrophysiological diagnosis and patterns of response to treatment of botulism with neuromuscular respiratory failure: electrophysiological pattern of recovery in botulism. Muscle Nerve. 2009;40(2):271–8.CrossRefPubMed

13.

Topakian R, Heibl C, Stieglbauer K, Dreer B, Nagl M, Knoflach P, et al. Quantitative autonomic testing in the management of botulism. J Neurol. 2009;256(5):803–9.CrossRefPubMed

Title: Benign food-borne type B botulism presenting as unilateral internal ophthalmoplegia: a case report
Authors: Francesco Crescenzo
Raffaele Del Colle
Domenico Ajena
Matteo Stecca
Laura Ferigo
Francesca Rossi
Michelangelo Turazzini
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Clostridium Botulinum
Ophthalmoparesis
Published in: BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-022-02939-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Benign food-borne type B botulism presenting as unilateral internal ophthalmoplegia: a case report

Abstract

Background

Case presentation

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

Stent-assisted coiling of acutely ruptured cerebral aneurysm: a multicenter prospective registry study (SAVE)

Boston cognitive assessment (BOCA) — a comprehensive self-administered smartphone- and computer-based at-home test for longitudinal tracking of cognitive performance

Safety and efficacy of low-dose rt-PA with tirofiban to treat acute non-cardiogenic stroke: a single-center randomized controlled study

Involuntary crying episodes with Susac’s syndrome—a rare presentation of a rare disease: a case report

Age-adjusted Charlson comorbidity index in recurrent glioblastoma: a new prognostic factor?

Recurrent headache and visual symptoms in a young man: a rare neuronal intranuclear inclusion disease case report