Case: 25 year old patient presented to emergency room with complaint of 2-day history of symmetrical and descending muscular weakness along with diplopia. He denies any fever or chills. He does give history of having an injury to the face. He works as a marine driller. His symptoms are progressively getting worse. His vital signs reveal no fever but bradycardia with heart rate of 48 and blood pressure of 120/80 mm hg. His vital capacity is 1 liter (33% of predicted). He was admitted to intensive care unit. What could be the probable diagnosis? (select one)
A) Myasthenia Gravis
B) Lambert-Eaton syndrome
C) Guillain-Barre’s syndrome
D) Poliomyelitis
E) Botulism
Answer: Botulism
Botulism has an acute onset with bilateral cranial neuropathies and symmetric descending weakness. Key features 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
Differential diagnosis:
- Mysthenia Gravis
- Lambert-Eaton syndrome
- Guillain-Barre’s syndrome
- poliolmyelitis
- Ticks paralysis
- heavy metal intoxication
#ID
Reference:
Jeffery IA, Karim S. Botulism. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29083673.
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