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A 6-month-old boy with normal development developed constipation, poor feeding and lethargy, then drooping of the eyelids, weak cry, head lag and limb weakness. He had normal septic and metabolic work-up and neuroimaging studies. Myasthenia gravis (MG) and congenital myasthenic syndrome (CMS) were initially considered; pyridostigmine trial showed no improvement. Examination (figure 1, video 1) revealed an alert child with sluggishly reacting pupils, horizontal ophthalmoparesis, proximal limb weakness and preserved tendon reflexes. Infant botulism …
Contributors LAB: acquisition of data, analysis and interpretation, drafting of the manuscript. PG: study concept and design, analysis and interpretation, critical revision of the manuscript for important intellectual content.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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