Botulism is a rare neuroparalytic disease requiring rapid identification and treatment. Foodborne toxaemia is well described but intestinal toxaemia is rare. Gastrointestinal (GI) abnormalities allow Clostridium botulinum to colonize the GI tract and release toxin systemically. Intestinal toxaemia has a unique protracted presentation with increased morbidity and mortality. Diagnosis is complicated by limited experience and conditions with similar symmetric descending paralysis.
We discuss intestinal toxaemia in a 48-year-old male with inflammatory bowel disease, who required a 140-day hospital stay including extensive intensive care management. We review the literature and outline the acute presentation, diagnosis, and empiric treatment with botulism antitoxin.
Intestinal toxaemia is a unique clinical entity with a protracted course and increased morbidity and mortality. Patients with GI abnormalities are at risk and early identification with empiric antitoxin treatment is crucial.
Key words: Botulism, Paralysis, Clostridium, Toxemia, Intestinal, Electromyography