To the Editor: In the Case Records of the December 4 issue, Dr. Newton E. Hyslop, Jr., remarked that the “unclassified” form of botulism in the adult may have the same pathophysiologic mechanism as infant botulism. Although confirmatory evidence is lacking, we suggest that some cases of “unclassified” botulism may result from endogenous toxin production due to predisposing factors in the host, e.g., disruption of the integrity of the intestine and an alteration in the balance of intestinal microflora. We have identified Type A botulism in a 33-year-old woman who had undergone ileojejunal bypass. An end-to-end ileojejunal anastomosis (10.2 cm.
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