Jiang Ruiji, Beland Benjamin, Shah Vinil, Kang Min, Pet Douglas B
Department of Neurology, University of California, San Francisco, USA.
Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Canada.
BMC Neurol. 2025 Aug 22;25(1):343. doi: 10.1186/s12883-025-04365-4.
Adult botulism is a rare, life-threatening condition typically caused by exposure to preformed botulinum neurotoxin (BoNT). Acute intestinal toxemia botulism (AITB) is an uncommon subtype resulting from colonization of Clostridium botulinum in the intestines. Diagnosis is made by detecting BoNT in the patient's blood, stool, or gastric fluid. AITB is confirmed when C. botulinum is isolated in culture. Electrodiagnostic studies may support the diagnosis, while imaging-when performed-is generally used to exclude alternative conditions.
A 74-year-old man presented with acute dysarthria and ophthalmoparesis, which rapidly progressed to quadriparesis and respiratory failure requiring intubation. Magnetic resonance imaging (MRI) revealed thickening and enhancement of the cauda equina nerve roots. Due to high clinical suspicion for botulism, heptavalent botulinum antitoxin was administered. Intravenous immunoglobulin was also given, as the imaging findings raised concern for an alternative diagnosis of Guillain-Barré syndrome (GBS). Blood and stool samples later tested positive for BoNT type A, and C. botulinum was isolated from the stool, confirming AITB. The patient experienced a gradual but prolonged recovery of motor function following treatment.
Botulism in both infants and adults is not typically associated with abnormal neuroimaging findings. To our knowledge, this is the first reported case of cauda equina nerve root thickening and enhancement on MRI in AITB-or in adult botulism more broadly. We outline the differential diagnosis, pathophysiology, and treatment of botulism. This case underscores that abnormal neuroimaging should not delay prompt empiric treatment for botulism when clinical suspicion is high.
成人肉毒中毒是一种罕见的、危及生命的疾病，通常由接触预先形成的肉毒杆菌神经毒素（BoNT）引起。急性肠道毒血症型肉毒中毒（AITB）是一种不常见的亚型，由肉毒梭菌在肠道内定植所致。通过检测患者血液、粪便或胃液中的BoNT进行诊断。当在培养物中分离出肉毒梭菌时，AITB得到确诊。电诊断研究可能支持诊断，而进行影像学检查时通常用于排除其他疾病。
一名74岁男性出现急性构音障碍和眼肌麻痹，迅速进展为四肢瘫痪和呼吸衰竭，需要插管。磁共振成像（MRI）显示马尾神经根增厚并强化。由于临床高度怀疑肉毒中毒，给予了七价肉毒抗毒素。还给予了静脉注射免疫球蛋白，因为影像学表现引发了对吉兰-巴雷综合征（GBS）替代诊断的担忧。血液和粪便样本后来检测出A型BoNT呈阳性，并且从粪便中分离出肉毒梭菌，确诊为AITB。治疗后患者运动功能逐渐但长期恢复。
婴儿和成人肉毒中毒通常与神经影像学异常表现无关。据我们所知，这是首例报道的AITB（或更广泛的成人肉毒中毒）患者MRI显示马尾神经根增厚并强化的病例。我们概述了肉毒中毒的鉴别诊断、病理生理学和治疗方法。该病例强调，当临床高度怀疑肉毒中毒时，神经影像学异常不应延迟对其进行及时的经验性治疗。
