An infantile case of Guillain-Barré syndrome mimicking infant botulism exhibiting ptosis: A case report

Guillain-Barré syndrome (GBS) and botulism primarily manifest as acute flaccid paralysis; thus, differentiating between these two conditions is challenging. However, reports describing this case in infants are rare. Herein, we report a rare case of infantile GBS with ptosis that was initially suspected to be infant botulism (IB). An 11-month-old boy presented with intermittent exotropia and was unable to stand with support. The patient also experienced constipation, ptosis, flaccid paralysis of both lower limbs, and loss of deep tendon reflexes within several days of admission. Brain MRI and cerebrospinal fluid (CSF) examination on day 3 were normal. Given the presence of ptosis and constipation, in addition to generalized hypotonia, IB was suspected. However, the stool botulinum toxin test results were negative. Repetitive nerve stimulation performed during evoked electromyography showed no waxing, and nerve conduction studies revealed the absence of F-waves in the lower limbs. Repeat CSF analysis on day 13 revealed albuminocytological dissociation. Anti-GM1 and anti-GQ1b IgG antibodies were positive. Based on these findings and the clinical symptoms, a final diagnosis of GBS was made. Without any specific treatment, his muscle strength and tone gradually improved from day 7. He was discharged on day 20. Motor development remained normal, with independent walking achieved within 15 months of age. This case highlights that infantile GBS may present with ptosis and mimic IB. Accurate diagnosis requires the synthesis of various clinical information, including the results of repeated CSF tests, neurophysiological studies, and analyses of toxins and anti-ganglioside antibodies. • Differentiating between GBS and IB is challenging. • GBS in infants below 1 year of age is rare. • Infantile GBS may present with ptosis and mimic IB. • Accurate diagnosis requires the synthesis of various information.