A multidisciplinary team at the UNC-CH recently published a Clinical Problem-Solving article in the New England Journal of Medicine detailing a rare and complex case of foodborne botulism. The article, led by the UNC Division of Infectious Diseases, walks readers through the diagnostic challenges posed by a 47 year old man who presented with dyspnea, ophthalmoplegia, and rapidly progressive descending paralysis.
While the case was spearheaded by UNC infectious disease physicians Dr. Salma M.A. Gayed and Dr. Michael P. Motley, the diagnostic process relied on close collaboration across specialties — including Neurology. Dr. Julia M. Carlson, Assistant Professor in the UNC Department of Neurology, contributed key neurologic expertise during the patient’s rapid clinical decline.
Dr. Carlson played a critical role in evaluating the patient’s unusual cranial nerve deficits, vocal‑cord paresis, and progressive paralysis, helping narrow the differential diagnosis to peripheral neuromuscular disorders and prompting further testing that ultimately supported the team’s suspicion for botulism and coordination with state authorities and the CDC for confirmatory evaluation and antitoxin administration. Her involvement highlights the essential role of rapid neurologic assessment in cases of acute ophthalmoplegia or descending paralysis—rare but life‑threatening neuromuscular emergencies—and the authors note that despite treatment, the patient’s prolonged paralysis underscores the importance of early recognition and intervention.
The full article, “The Eyes Have It,” appears in the March 5, 2026 issue of the New England Journal of Medicine.
N Engl J Med 2026;394:1011-7. DOI: 10.1056/NEJMcps2508044. Copyright © 2026 Massachusetts Medical Society.