On November 23, 1997, a previously healthy man became nauseated, vomited, and complained of abdominal pain. During the next 2 days, he developed double vision, difficult movement of joints, and respiratory impairment. He was hospitalized and placed on mechanical ventilation. His physical examination confirmed multiple cranial nerve abnormalities, including extraocular motor palsy and diffuse flaccid paralysis. Botulism was diagnosed, and antibotulinum toxin was administered. His blood serum demonstrated the presence of type B botulinum toxin. A food history revealed no exposures to home-canned products; however, the patient had eaten pickled eggs that he had prepared seven days before his symptoms began. The patient recovered after a prolonged period of supportive care.

The pickled eggs were prepared using a recipe that consisted of hard-boiled eggs, commercially prepared beets and hot peppers, and vinegar. The intact hard-boiled eggs were peeled and punctured with toothpicks then combined with the other ingredients in a glass jar that closed with a metal screw-on lid. The mixture was stored at room temperature and occasionally was exposed to sunlight.

Cultures revealed Clostridium botulinum type B, and type B toxin was detected in samples of the pickled egg mixture, the pickling liquid, beets, and egg yolk. The commercially sold peppers contained no detectable toxin or Clostridium botulinum bacteria. Beets from the original commercial containers were not available. The pH of the pickling liquid was 3.5 (i.e., adequate to prevent C. botulinum germination and toxin formation, however, the pH of egg yolk, although not tested for the investigation, is normally 6.8., conducive for bacteria growth and toxin production. Inadequate acidification and lack of refrigeration enhanced the risk of bacterial contamination of this home-prepared food.