Flaccid paralysis in an infant associated with a dirty wound and application of honey

• Published in: BMJ case reports Vol. 2017; p. bcr2016218044
• Main Authors: Joseph, Charlotte Jane, Khoo, Teik Beng, Lee, Keng Yee
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 06.01.2017; BMJ Publishing Group
• Series: Case Report
• Subjects: 12 months; Abdomen; Asia; Babies; Botulinum toxin; Botulism; Botulism - diagnosis; Botulism - drug therapy; Case reports; Cholinesterase Inhibitors - therapeutic use; Debridement - methods; Disease control; Fasciitis, Necrotizing - microbiology; Fasciitis, Necrotizing - therapy; FDA approval; Honey; Humans; Immunoglobulins, Intravenous - therapeutic use; Infant; Male; Other Asian; Paralysis - microbiology; Penicillin; Pyridostigmine Bromide - therapeutic use; Rare Disease; Treatment Outcome; Ulcer - microbiology; Ulcer - therapy; Umbilicus; Wound Infection - therapy; United States > US; Malaysia
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2016-218044

An infant, who was born preterm at 36 weeks, presented with fever and ulcer at umbilical region which progressed to necrotising fasciitis of anterior abdominal wall. He was treated with intravenous penicillin, intravenous cloxacillin and local application of medicated honey. Subsequently, he required wound debridement. Postoperatively, he required prolonged invasive ventilation due to poor respiratory effort which was associated with hypotonia and areflexia. Nerve conduction study revealed absent responses. The diagnosis of infant botulism was made based on the clinical presentation, nerve conduction study and his clinical progress. Botulinum immunoglobulin was not available. He was treated with intravenous immunoglobulin and oral pyridostigmine. He was successfully extubated after 37 days, and currently the patient is doing well.