When Home Cooking Turns Hazardous: Two Botulism Cases

Abstract

Introduction: Botulism is a rare, potentially life-threatening neurotoxin-mediated disease caused by the anaerobic, grampositive bacterium Clostridium botulinum, and occasionally by related species such as C. baratii and C. butyricum. The diagnosis of botulism relies on clinical suspicion and a comprehensive neurologic examination. Timely diagnosis is crucial.

Case Report: A 62-year-old woman presented to our department with diplopia, dysarthria, dysphagia, and hoarseness, which had developed over the past four days. She had a recent history of vomiting 48 hours after consuming homemade pumpkin preserves, followed by the onset of dysphagia, diplopia, dysarthria, and hoarseness 48 hours later. Neurological examination revealed dysphonia with a “hoarse” voice and an asymmetry of the pharyngeal reflex, more pronounced on the right. Laboratory tests showed no significant abnormalities. Brain CT scan results were unremarkable. Botulinum toxins were detected in her blood, and botulinum toxin-producing clostridia were found in rectal swabs. A diagnosis of foodborne botulism was established, and botulinum antitoxin was administered. The patient’s symptoms improved rapidly, with diplopia being the only persisting symptom. She was discharged after 7 days with indications for orthoptic rehabilitation. Several days later, the patient’s husband, who had also consumed the homemade preserve, was admitted to the emergency room with similar symptoms, including constipation, dysphagia, dysarthria, diplopia, and eyelid ptosis. Botulinum toxins were not detected in his blood, but botulinum toxin-producing clostridia were found in rectal swabs. He received antibotulinum serum, leading to symptom improvement. He was discharged after five days with mild eyelid ptosis, and orthoptic rehabilitation was recommended.