Disclosures: Jonathan Wolbert, DO: No financial relationships or conflicts of interest

Case Diagnosis: A 5-month-old female was found to have infantile botulism.

Case Description: A 5-month-old female born vaginally and full term with no postnatal complications presented with a 1 week history of constipation and decreased appetite. The day before presentation she had poor suck, did not feed well, and had no wet diapers. She was given a fingertip of honey 2 weeks prior to presentation, and there was an active construction site near the home. On examination, the patient was well nourished but ill appearing with ptosis, poor suck reflex, weak cry, hypotonia, and rhinorrhea. Reflexes were present in all extremities. Neurosonogram was unremarkable. EMG/NCS confirmed a presynaptic neuromuscular junction disorder (Botulism) and the patient was given a one time dose of Infant Botulism Immune Globulin Intravenous (BabyBIG-IV) with significant improvement. After treatment, the stool cultures confirmed botulinum toxin type B in the stool. The patient was later discharged home in stable condition.

Setting: Pediatric ICU.

Assessment/Results: With EMG/NCS confirmation the patient was able to be successfully treated with BabyBIG-IV, even prior to the results of the stool cultures thus highlighting the utility of an EMG/NCS in this setting.

Discussion: Infantile Botulism in the USA is a rare occurrence with approximately 77 cases annually. EMG/NCS was performed with repetitive nerve stimulation, where there was decrement noted in two different motor nerves, and evidence of ongoing denervation in the right bicep and early recruitment in others. Due to the potency of botulinum toxin at the neuromuscular junction, the muscle fibers are essentially chemo-denervated and fibrillations and positive sharp waves are common.

Conclusion: This case report highlights the necessity of an early EMG/NCS study when botulism is suspected. This patient had the unfortunate exposure from two potential sources, however EMG/NCS was able to confirm the suspected diagnosis of infantile botulism even prior to stool culture results.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/how-an-early-emg-ncs-led-to-early-treatment-a-case-study-on-infantile-botulism/