Infant botulism presenting with poor feeding and lethargy: a review of 4 cases.

Infant botulism is a rare cause of hypotonia in young infants. It may present with vague symptoms such as poor feeding and lethargy. We present 4 cases of infant botulism presenting to 2 community hospitals in central Maryland. In each case, poor feeding and lethargy were the chief complaints. One patient was referred to the emergency department with suspected sepsis and one with suspected intussusception. Three patients required endotracheal intubation. All were treated with botulism immune globulin, and all eventually made full recoveries. We discuss the differential diagnosis and provide an overview of infant botulism.