Infantile Botulism in the Absence of Dietary Exposure to Honey: A Case Likely Related to Environmental Spore Exposure

Infantile botulism is a rare but potentially life-threatening neuroparalytic condition caused by botulinum toxin produced by Clostridium botulinum colonizing the infant's gastrointestinal tract. Early manifestations are often subtle and nonspecific, frequently leading to delayed or missed diagnosis. We report a case of a four-week-old infant who developed progressive hypotonia and respiratory compromise secondary to infantile botulism. The diagnosis was confirmed by detection of botulinum toxin in the stool, and the patient was treated promptly with botulism immune globulin. This case highlights the importance of considering neuromuscular etiologies such as botulism in infants presenting with atypical or unexplained respiratory decline. Increased awareness of its distinguishing features and early recognition are critical to prevent progression to respiratory failure.