A case of infant botulism in a 4-month-old baby.
### Learning point for clinicians

This case report highlights: (i) the difficulty of infant botulism (IB) diagnosis as it is a rare disease, (ii) the efficacy and safety of trivalent equine antitoxin in IB treatment, (iii) honey is not the only cause of IB and (iv) the need for physician training to recognize and diagnose IB.

A 4-month-old baby (7 kg) was admitted to the Pediatric Department for constipation, feeding difficulties, weak cry, lethargy and weak muscular body control. Symptoms of infant botulism (IB) appeared 1 month before the admission, after hexavalent vaccine administration, with a slow and progressive evolution. The baby has become lethargic, with blunted facial expression and weak cry. Seven days before admission he started refusing breast milk. Clinical history revealed no perinatal or delivery complications and the baby was normal for development and growth (50th percentile). On admission the baby was fully conscious and the initial …