Two brothers, 38 and 42 years old, came to the emergency department with blurred vision for 24 hours, worse in vision.
They habitually consumed cocaine, and related the current symptomatology with it, since it was the circumstance that the previous day had changed the provider.
In both cases, distant visual acuity was preserved (0.8), but visual acuity was less than 0.4.
They had bilateral reactive mydriasis that returned within minutes after instilling 1% pilocarpine.
Extrinsic eye movements, convergence and the rest of the examination were normal.
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They were cited for reassessment, diagnosed with possible mydriasis by adulteration of the drug.
Two days later, the patient developed bilateral ptosis and diplopia.
There was limitation of affection in both eyes, and the rest of the cardinal positions of the gaze were only slightly restricted.
In addition, they manifested nausea, vomiting, dysphagia and voiding difficulty.
Deepening the anamnesis, they commented that two days before the onset of symptoms they had consumed canned meats prepared by hand.
The possibility of Clostridium difficile poisoning was proposed.
The cranial imaging tests performed (computed tomography) were normal.
Not so the electromyograms, which showed a blockade at the level of the muscle motor plate, so the administration of botulinum antitoxin was initiated.
The child of siblings required hospital care for eighteen days, and the largest twenty-four days required mechanical ventilation.
Detection of toxin in faeces was negative in both.
The ocular pathology remitted completely and inversely to how it had occurred.
Mydriasis did not completely disappear after 40 days of its onset, and the improvement was somewhat earlier in the younger brother, who suffered the least serious condition.
