TRANSIENT TONIC PUPILS IN BOTULISM TYPE-B

We report a 29-year-old woman who developed unilateral unreactive mydr iasis and cycloplegia after 5 days of persistent constipation. During the next hours the patient complained of dry mouth and difficulties in swallowing food; iris and ciliary muscle palsies spread over the seco nd eye. Ocular motility was normal and there were no clinical signs of neuromuscular involvement. Conventional electromyography and evoked m uscle action potentials following repetitive nerve stimulation were no rmal; single-fiber electromyography showed normal jitter and absence o f blocking. The diagnosis of botulism was considered as most likely, a nd the patient was given botulinum antitoxin. The post-treatment cours e was characterized by bilateral tonic pupillary reaction to near, sec toral iris contractions to light and pupillary constriction to 2 mm in 40 min following topical instillation of 0.1% pilocarpine. Ocular man ifestations completely disappeared within 5 weeks. Botulism type B tox in was demonstrated in the pretreatment stool of the patient but not t he serum. (C) 1998 Elsevier Science B.V.