Confusion in deglutition: A case of Botulinum Toxin Ingestion

ABSTRACT

Purpose@#To report on a case of dysphagia secondary to botulinum toxin ingestion. @*Method@#Case report @*Result@#A 30-year-old female with no comorbidities, presented with dysphagia associated with ptosis and diplopia 12 hours after ingestion of double dead pork. Probable diagnoses of a neurologic, esophageal problem or a neoplasm were initially considered. Ancillary procedures to support diagnoses were performed including esophagogastroduodenoscopy, cranial CT scan and Facial and Extremity Nerve Conduction Velocity which all revealed unremarkable results. A possible polyneuropathy specifically foodborne toxicity was considered given a history of dysphagia, ptosis and diplopia with consumption of double dead pork. Confirmatory stool culture studies revealed Clostridium botulinum, hence appropriate antibiotics and supportive therapy were provided which led to the patient's recovery. @*Conclusion@#Early diagnosis and a high index of suspicion is important in cases with unfamiliar presentations, therefore a careful history and physical examination is warranted. Foodborne botulinum toxicity is a public health matter that should be addressed. Proper food handling and storage must always be practiced.