Introduction We report a case of infant botulism caused by artisanal honey. Infant botulism results from a heat-labile neurotoxin produced by ingested Clostridium botulinum which blocks voluntary motor and autonomic functions. There is no consensus about treatment.

Case report A four-month old girl, without any previous history, was hospitalized in emergency for acute hypotonia and lethargy. Parents reported poor feeding, and constipation. She rapidly developed respiratory failure and needed supportive intensive care, including mechanical ventilation. Clinical examination showed a major hypotonia with slow pupil response. She developed an antidiuretic hormone excess. The virological, bacteriological, toxicological and metabolic check-up was negative. MRI and electromyogram were normal. Belatedly, the parents confessed to dipping the patient’s pacifier in artisanal honey over a few weeks. Blood, stool and honey samples were sent for culture. Stool cultures showed neurotoxin of Clostridium botulinum type B. The patient’s clinical status improved spontaneously with good recovery.

Discussion The possible origins of botulinic spores are dust and honey. Treatment consists of nutritional and respiratory support until new motor endplates are regenerated. There is no indication for antibiotics; it has been reported that it would increase bacteria proliferation and toxin liberation. An antidiuretic hormone excess is described.

Conclusion Infantile botulism classically presents with bulbar palsies, ptosis, constipation and poor feeding. Diagnosis is clinical. Sometimes a classic electromyogram pattern can be found. Diagnosis is confirmed by isolating the organism or toxin. This case, like others described in literature, leads us to recommend that honey should not be given to very young infants.