Work

Two Cases of Severe Food-Borne Botulism: Could High-Dose Methylcobalamin Accelerate Recovery?

Year: 2025

Type: article

Abstract: Botulinum neurotoxins (BoNTs) are zinc-dependent endopeptidases that cleave presynaptic SNARE proteins and arrest acetylcholine release, producing flaccid paralysis with protracted recovery. We report two cases of a mother and son who developed severe food-borne botulism after eating Fesikh (traditional salted fish) with rapidly progressive descending paralysis requiring ventilation, prominent dysautonomia (hypotension responsive to fluids, bradycardia, dry mucosae, constipation with abdominal distension, as well as urinary retention), and intact consciousness. Both received trivalent antitoxin on day 2; the son was extubated on day 10, and the mother on day 16. Persistent bladder atony, fatigue, weakness, and poor concentration improved with structured physiotherapy accompanied by intramuscular methylcobalamin, which was initiated on day 1 of admission and subsequently transitioned to an eight-week course of oral methylcobalamin (500 µg daily) during the post-extubation rehabilitation phase. We discuss mechanistic plausibility and hypothesize that higher-dose methylcobalamin might accelerate neuromuscular recovery by stabilizing mitochondria, attenuating caspase-mediated apoptosis, and promoting axonal regeneration and sprouting.

Source: Cureus

DOI: 10.7759/cureus.94339

Author: Islam A Aied

Institutions: Ain Shams University, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Soliman Fakeeh Hospital

Language: English

Topic: Botulinum Toxin and Related Neurological Disorders

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4415077519