Botulinum toxin poisoning of food origin with neurological manifestations as the first symptom:A case report and differential diagnosis / 中风与神经疾病杂志

ABSTRACT

@#Botulinum toxin poisoning is a neuroparalytic disorder caused by botulinum toxin,mostly involving the presynaptic membrane of cranial nerves and peripheral neuromuscular junctions,manifesting as flaccid,symmetrical,descending paralysis. Due to the diverse clinical manifestations,it is easily confused with myasthenia gravis and Guillain-Barré syndrome in the absence of a clear history of suspected food consumption. We report a case of botulinum toxin poisoning characterized by fluctuating myasthenia gravis,bilateral ptosis,dysphagia,and double vision in our hospital. The patient denied a history of food or drug poisoning,had a positive fatigue test and a positive neostigmine test,and was initially diagnosed with myasthenia gravis. After treatment with pyridostigmine bromide,hormones,and immunosuppressants,there was no significant relief of symptoms. After detailed questioning,the patient recalled that his family members and friends had mild malaise and dizziness,which were initially overlooked. They had consumed the same homemade raw sauce from a jar at different times prior to the onset of the illness. Serological tests confirmed the diagnosis of botulinum toxin type A poisoning in the patient,as well as his family members and friends. Early diagnosis is key to the management of botulism poisoning. Patients presenting with fluctuating myasthenia,bilateral ptosis,dysphagia,and double vision should be questioned in detail about their history of consuming suspected food to rule out botulinum toxin poisoning,thereby avoiding misdiagnosis and delayed treatment.