Early Recognition and Management of Foodborne Botulism in an Adult: A Case Report

Introduction: Botulism is a rare but potentially fatal acute neuroparalytic disorder with diagnostic challenges due to overlapping neurological presentations and delayed toxin testing. In such settings, electrophysiological studies support differential diagnosis, while respiratory function measurements—particularly peak expiratory flow—aid in early identification of respiratory muscle involvement and planning of ventilatory support. Prompt antitoxin administration remains the cornerstone of treatment and is critical for limiting disease progression.Case Report: A previously healthy 27-year-old man presented with nausea, blurred vision, diplopia, and dysphagia after consuming canned food. Neurological examination revealed bilateral ophthalmoplegia, ptosis, bulbar dysfunction, and mild descending weakness with preserved sensation. Laboratory tests and neuroimaging were unremarkable. Pulmonary function testing showed a peak expiratory flow of 64% of the predicted value, suggesting early respiratory involvement. A presumptive diagnosis of foodborne botulism was made, and heptavalent antitoxin was administered 16 hours after symptom onset. Due to progressive bulbar symptoms, elective mechanical ventilation was required. Electrophysiological studies demonstrated an incremental response on high-frequency repetitive nerve stimulation. The patient recovered fully without sequelae.Conclusion: This case underscores the value of a clinically driven approach integrating electrophysiology and respiratory assessment for timely diagnosis, airway management, and early antitoxin therapy when definitive confirmation is unavailable.