BMJ Case Reports 2017; doi:10.1136/bcr-2016-218044

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

Open Access
  1. Keng Yee Lee2
  1. 1Paediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  2. 2National Clinical Research Center, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  1. Correspondence to Dr Charlotte Jane Joseph, charlottejanejoseph{at}
  • Accepted 16 December 2016
  • Published 6 January 2017


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.


  • Contributors CJJ, TBK and KYL contributed to conception and design, writing of the abstract and case report.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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