A childhood-onset intestinal toxemia botulism during chemotherapy for relapsed acute leukemia

Abstract

BackgroundBotulism is a potentially fatal infection characterized by progressive muscle weakness, bulbar paralysis, constipation and other autonomic dysfunctions. A recent report suggested that cancer chemotherapy might increase the risk for the intestinal toxemia botulism in both adults and children.Case presentationWe report a 5-year-old boy, who developed general muscle weakness, constipation, ptosis and mydriasis during the third induction therapy for relapsed acute myeloid leukemia. He had recent histories of multiple antibiotic therapy for bacteremia and intake of well water at home. Repeated bacterial cultures identified Clostridium botulinum producing botulinum neurotoxin A. Botulinum toxin A was isolated from his stools at 17, 21, and 23 days after the onset. Symptoms were self-limiting, and were fully recovered without anti-botulinum toxin globulin therapy.ConclusionThis is the second report of a pediatric case with cancer chemotherapy-associated intestinal toxemia botulism. Our case provides further evidence that the immunocompromised status due to anti-cancer treatments increases the risk for the development of botulism at all ages in childhood.

Adult Intestinal Toxemia Botulism

“…The clinical presentation of adult intestinal toxemia botulism is similar to other forms of botulism. Initial symptoms may include one or more of nausea [46,47], vomiting [46][47][48], generalized muscle weakness [67], bloating [39] or distended abdomen [37,38,44,47,48,66], decreased bowel sounds [37,38], abdominal pain [39,[46][47][48], and constipation [38,39,41,46,48,67], in some cases lasting weeks to months [36]. Cranial nerve palsies may result in one or more cases of blurred vision, diplopia, ptosis, ophthalmoplegia, dysarthria, and dysphagia.…”

“…Because there have been so few cases, there is no standard treatment. Antitoxin is not always administered [41,67]. Antibiotics are sometimes administered [36,39,41]; however, the usefulness of antibiotics has been questioned [28] as they cause further disruption of the normal intestinal microbiota [47] and spores may continue to be shed for weeks to months [37].…”