Hospital-acquired intestinal toxemia botulism in a newly diagnosed adult colon cancer patient

Abstract

This manuscript reports a case of intestinal toxemia botulism in an adult with recently diagnosed metastatic colon cancer in whom botulism symptoms began 23 days after hospital admission. Representing the rarest form of botulism presentation in clinical practice, this infectious disease may have developed due to a cluster of predisposing factors that favored Clostridium botulinum colonization and the endogenous production of neurotoxins, among which are previous use of broad-spectrum antibiotics and colon changes related to the development of the neoplasia. This case highlights the importance of considering intestinal toxemia botulism in the differential diagnosis of a patient presenting with symmetrical descending flaccid paralysis, since immediate treatment with botulinum antitoxin may improve clinical outcomes.

Adult Intestinal Toxemia Botulism in a Patient With Crohn's Disease

“…4 Although this form of botulism can occur in patients with no identifiable risk factors, 16 cases of ITB have been reported in patients who had distorted GI anatomy, gastric or bowel resection, or endoscopy. 3,[6][7][8][9][10][11][12][13][14][15][16] Twelve of these patients were women, and the age of presentation ranged between 33 and 79 years. The time to diagnosis was less than 3 days in 50% of cases.…”

“…C. baratii type F toxin was reported in 5 cases. 3,[6][7][8][9][10][11][12][13][14][15][16] The pathogenesis of ITB is unclear, but the association of altered GI anatomy, IBD, and resultant colonization of clostridia and ITB suggests the interplay of dysbiosis, altered immune, and inflammatory responses in the pathogenesis of this condition. Only 3 ITB cases with altered GI anatomy had an associated diagnosis of IBD were reported in the literature.…”