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6-month old with new-onset weakness: consider infant botulism
  1. Luisa Angel Buitrago,
  2. Partha Ghosh
  1. Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Partha Ghosh, Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA; partha.ghosh{at}

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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 …

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  • 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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