[Generalized fulminant descending paresis]

We report the case of an 83-year-old female patient with fulminant tetraparesis and respiratory failure who required mechanical ventilation. After exclusion of some important differential diagnosis we gave antitoxin under the presumptive diagnosis of botulism. The clinical suspicion was confirmed by the serological detection of botulinum toxin. The patient showed six months after the onset of the disease a little improvement of the tetraparesis and was intermittent ventilator-dependent. In the commentary we discuss, basing on the literature, some important epidemiological, microbiological, clinical and therapeutically clues.