Food-borne botulism, initially mistaken for plant intoxication

Henneke N. Mulder-Spijkerboer, Marieke A. Dijkman, Dylan W. De Lange, Irma De Vries

Research output: Contribution to journalMeeting AbstractAcademic

Abstract

Objective: We present a rare case of botulism in the
Netherlands, initially mistaken for plant intoxication. This demonstrates
the importance of carefully assessing symptoms in
patients with presumed plant intoxication, rather than focusing
on specific plants in their garden.
Case report: An 81-year-old woman was brought to the
Emergency Department (ED) after eating homemade pesto from
wild garlic (Allium ursinum) from her own garden. Upon presentation,
her symptoms included nausea, vomiting, and drowsiness,
soon followed by dry mouth, dysphagia, ptosis, bradycardia,
orthostatic hypotension, and hypoventilation. She became
increasingly respiratory insufficient and needed mechanical ventilation.
The Emergency Department physician found on an
Internet search that lily-of-the-valley (Convallaria majalis) can be
mistaken for wild garlic and contacted the Poisons Information
Center (DPIC) for information on possible effects and treatment.
The specialist in poison information discussed the symptoms of
lily-of-the-valley intoxication with the physician, who thought this
intoxication could explain the symptoms. However, a neighbour
said that the patient did not have lily-of-the-valley in her garden,
but did have autumn crocus (Colchicum autumnale) growing near
the wild garlic. Autumn crocus is also notorious for being mistaken
for wild garlic. The patient deteriorated and developed
severe muscle weakness, renal dysfunction, and paralytic ileus.
Although some of her symptoms could be explained by intoxication
with autumn crocus, the complete picture did not correspond
well with intoxication with autumn crocus or other
poisonous plants. Based on her symptoms, botulism was put forward
as a possible cause of illness. Her descending paralysis and
dysfunction of the autonomic nerve system matched the effects
of botulinum toxin. The patient was treated with botulism antitoxin
and she gradually recovered. Eleven days after presentation,
she was transferred from intensive care to the neurology department.
She was discharged 9 days later and transferred to a nursing
home with persistent dysphagia. Feces of the patient tested
positive for botulinum toxin, but the pesto tested negative. Upon
inquiry, it turned out that the patient had expired foods, including
salmon at home. The salmon was not kept in the refrigerator
and was marked as the likely source of botulinum toxin.
Unfortunately, the salmon was thrown away by a neighbour and
could not be analyzed.
Conclusion: This case demonstrates that a reported plant ingestion
by a patient does not necessarily mean that plant
576 ABSTRACTS
intoxication is the cause of illness. It is important to keep an
open mind and assess all reasonable causes.
Original languageEnglish
Pages (from-to)576-577
JournalClinical Toxicology
Volume56
Issue number6
Publication statusPublished - 2018

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