219 - Functional Recovery Following Botulism: An Inpatient Rehabilitation Perspective

Case Diagnosis: Botulism

Case Description: A 67-year-old man with OSA, asthma was admitted 12/24/2024 with abdominal symptoms concerning for small bowel obstruction, followed by abrupt respiratory decline requiring intubation. He developed severe ptosis, dysphagia, respiratory failure, and proximal > distal weakness, raising concern for botulism. Definitive diagnosis was inconclusive, but he received botulinum antitoxin and plasma exchange with moderate improvement. He transferred to inpatient rehabilitation on 1/14, requiring ventilator pressure support, NG tube feeds, and maximal assistance for ADLs and mobility. His course was complicated by septic shock from ventilator-associated pneumonia, but he gradually improved. By rehabilitation discharge 3/21, he used BiPAP nocturnally and 1L during the day, was self-catheterizing, continent of bowel, eating primarily by mouth with PEG supplementation, and ambulating with a cane or walker. He regained independence with most ADLs. At 1-month follow-up, his PEG was removed and he was ambulating independently without gait aids.

Discussions: This case details the functional progression from botulism in the lens of inpatient rehabilitation. Neurogenic bowel appeared to improve early in the rehabilitative stay, with slow progression of independent oxygenation, i.e. decannulation by one week prior to discharge. Patient improved from max assistance in all ADLs, to largely independent of most ADLs by time of discharge. Lingering deficits in function included the need for straight catheterizations, dysphagia requiring IDDSI 5 restriction and supplemental tube feeds. This case report may aid physiatrists as a road map for botulism while admitted to inpatient rehabilitation. 

Conclusions: During a two month rehabilitation stay, a detailed account of this patient’s recovery from botulism may help guide focus on particular functional deficits as well as their potential timeline.