Disclosures: Kayli Gimarc, MD: Nothing to disclose

Case Description: Patient presented with progressive diplopia, hypophonia, bulbar and proximal limb weakness, and respiratory distress, requiring intubation on hospital day 8. Broad differential diagnoses including myasthenia gravis, Lambert-Eaton and atypical acute inflammatory demyelinating polyradiculopathy (AIDP) were excluded with laboratory and electrodiagnostic testing. A clinical diagnosis of adult intestinal overgrowth of Clostridium botulinum was suspected given clinical presentation and electrodiagnostic testing demonstrating a myopathic pattern consistent with pre-synaptic neuromuscular junction disorder. Patient was treated with botulism antitoxin and penicillin G on days 15–27. Inpatient rehabilitation (IPR) course was notable for significant functional improvement.

Setting: Tertiary care hospital

Patient: A 54-year-old woman with Crohn’s disease on immunosuppression and short bowel syndrome presenting with bowel obstruction, ptosis, dyspnea, and bulbar and proximal weakness.

Assessment/Results: Return of proximal muscle strength began on day 17. Respiratory function improvement was noted on day 19 with negative inspiratory force (NIF) of –14. She was admitted to IPR on day 38. During rehabilitation, bulbar, respiratory, and proximal weakness improved, allowing for verbal communication, tracheostomy decannulation, neck extension without external support, and ambulation. Oropharyngeal weakness continued, and she remained NPO at discharge, day 54.

Discussion: Botulism is rarely on the differential diagnosis of neuromuscular junction disorders in the adult setting. There have only been 33 cases of intestinal botulism worldwide in the literature, and this is the first description of rehabilitation course and functional recovery.

Conclusion: Adult onset intestinal botulism is rare though important to recognize given that an early diagnosis is life-saving. Furthermore, prior identification of etiology of symptoms, as seen in this case, allows better predication for time course and pattern of recovery to guide a comprehensive IPR program.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rehabilitation-course-of-a-patient-with-intestinal-overgrowth-causing-adult-onset-botulism-a-case-report/