Previously healthy middle-aged woman who had home-canned foods who presents with GI symptoms, ocular symptoms, and autonomic symptoms with normal deep tendon reflexes, most consistent with Botulism
Key idea: Adult-onset botulism associated with consumption of canned foods, whereas infant-onset botulism (floppy baby syndrome) associated with consumption of honey and exposure to dust (construction site, etc.)
Guillain-Barre syndrome โ> Ascending weakness over course of weeks associated with sensory symptoms and loss of deep tendon reflexes
Myasthenia gravis โ> Often does not present acutely, would not present with autonomic symptoms and history often includes weakness that worsens with continued use, associated with thymoma
Lambert-Eaton syndrome โ> Often does not present acutely, presents with autonomic dysfunction and diminished/absent deep tendon reflexes, and improves with continued use, associated with small cell lung cancer
why not myastehnia for this one? They put some LE weakness in the stem as well so that before respiratory depression made me skeptical of it being a pure descending paralysis and I went with MG instead .
study_dude_guyI think the history just points more towards Botulism or GBS. Tbh I'm not even entirely sure why this was Botulism and not GBS+2
seagullThe nausea, vomiting, and diarrhea are also good cues that this is a foodborne illness. Then the DTR are mildly dulled which won't happen in myasthenia gravis +
derpymdThe confusion for me is the timeline. She consumed the food 32 hours prior and symptoms started at around 24 hours. I figured with preformed toxins, the timeline would be more similar to Staph aureus (i.e. just a few hours).
The learning point for me here was that it can take 12-72 hours for symptoms to occur depending on dose.+
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