{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T18:00:07Z","timestamp":1767204007655,"version":"3.48.0"},"reference-count":25,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurology International"],"abstract":"<jats:p>Background: Botulism is a rare but potentially fatal neuroparalytic illness caused by Clostridium botulinum neurotoxins (BoNTs). While adult cases usually result from foodborne exposure or wound infection, intestinal colonization is exceedingly uncommon. Diagnosis can be delayed by overlap with other neuromuscular syndromes, and confirmation requires specialized assays. Anti-GQ1b antibodies, classically associated with Miller\u2013Fisher syndrome (MFS), have rarely been reported in confirmed botulism, raising questions about shared pathophysiology. Case Presentation: We describe an adult patient with acute dyspnea, xerostomia, and cranial neuropathies. No foodborne source was identified, but intestinal colonization of BoNT\/B toxigenic Clostridium botulinum was confirmed by stool enrichment and mouse lethality bioassay. The patient improved promptly following heptavalent antitoxin. Unexpectedly, anti-GQ1b antibodies were detected during recovery, a finding typically linked to MFS rather than botulism. Discussion: This case illustrates the diagnostic challenges of sporadic cases of botulism, especially when respiratory compromise and autonomic dysfunction dominate the initial presentation. The autoantibodies finding raises the possibility of molecular mimicry, whereby toxin\u2013ganglioside interactions expose neuronal epitopes and trigger an immune response. While causality cannot be proven, the overlap between botulism and GQ1b-positive neuropathies merits further investigation. Conclusions: Clinicians should maintain high suspicion for botulism in adults with acute dyspnea, especially when associated with cranial neuropathies, even in the absence of foodborne exposure. Anti-ganglioside antibodies in this context should be interpreted with caution, as they do not exclude botulism but may highlight immunological overlap with autoimmune neuropathies.<\/jats:p>","DOI":"10.3390\/neurolint18010008","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T17:24:58Z","timestamp":1767201898000},"page":"8","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adult Botulism of Unknown Source with Post-Toxin Anti-GQ1b Antibodies: Implications for Molecular Mimicry\u2014A Case Report"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7773-350X","authenticated-orcid":false,"given":"Regev","family":"Cohen","sequence":"first","affiliation":[{"name":"Infectious Diseases Unit, Hillel Yaffe Medical Center, Hadera 38100, Israel"},{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adi","family":"Hersalis Eldar","sequence":"additional","affiliation":[{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Neurology Department, Hillel Yaffe Medical Center, Hadera 38100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaron","family":"River","sequence":"additional","affiliation":[{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Neurology Department, Hillel Yaffe Medical Center, Hadera 38100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6379-9292","authenticated-orcid":false,"given":"Ofir","family":"Schuster","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona 74100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zina","family":"Baider","sequence":"additional","affiliation":[{"name":"Botulism National Reference Laboratory, Kimron Veterinary Institute, Bet Dagan 5025001, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelly","family":"Lipman-Arens","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Hillel Yaffe Medical Center, Hadera 38100, Israel"},{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yael","family":"Galnoor Tene","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Hillel Yaffe Medical Center, Hadera 38100, Israel"},{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linor","family":"Ishay","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Hillel Yaffe Medical Center, Hadera 38100, Israel"},{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lamis","family":"Mahamid","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Hillel Yaffe Medical Center, Hadera 38100, Israel"},{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga","family":"Feld Simon","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Hillel Yaffe Medical Center, Hadera 38100, Israel"},{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina","family":"Avshovitch","sequence":"additional","affiliation":[{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Internal Medicine D, Hillel Yaffe Medical Center, Hadera 38100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvira","family":"Zbiger","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Hillel Yaffe Medical Center, Hadera 38100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eran","family":"Diamant","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona 74100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amram","family":"Torgeman","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona 74100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elad","family":"Milrot","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona 74100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4590-6151","authenticated-orcid":false,"given":"Ofir","family":"Israeli","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona 74100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shlomo","family":"Shmaya","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona 74100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Itzhak","family":"Braverman","sequence":"additional","affiliation":[{"name":"Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Ear Nose and Throat Department, Hillel Yaffe Medical Center, Hadera 38100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5451-9997","authenticated-orcid":false,"given":"Shlomo E.","family":"Blum","sequence":"additional","affiliation":[{"name":"Botulism National Reference Laboratory, Kimron Veterinary Institute, Bet Dagan 5025001, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7002a1","article-title":"Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021","volume":"70","author":"Rao","year":"2021","journal-title":"MMWR Recomm. 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