The dilemma of diagnosing wound botulism in an infant: A rare case of paralysis with topical application of honey

•Botulism is a form of paralysis caused by a neurotoxin from the bacterium Clostridium botulinum; wound botulism rarely occurs.•We present a very rare case of wound botulism in an infant, possibly associated with the application of medical-grade honey.•In this case there was a high association of honey consumption and botulism; the importance of honey in topical wound care is questionable.•We review the dilemma regarding the difficulty of confirmation and achieving the diagnosis. Botulism is a form of paralysis caused by a neurotoxin produced by the bacterium Clostridium botulinum. It is well known that natural honey contains Clostridium botulinum spores; controversy arises when a honey-related product is being used for wound care, where the possibility occurs of applying these spores to an open wound. To our knowledge, no reported cases of medical-grade honey have been associated with wound botulism. Given this fact, do we feel secure regarding the safety of this product, and will it be enough to alleviate our concern? We present a case of an infant with an infected umbilical stump, which required a surgical wound debridement. This infant developed a sudden progressive flaccid paralysis a few days after the application of topical medical grade honey for wound care. Even though suspicion of wound botulism is high, confirmation of the diagnosis, detection of neurotoxin, and isolating the organism remains a challenge.