A 3-year-old standardbred racehorse gelding presented to Cornell University’s Equine and Nemo Farm Animal Hospital September of 2018 with a chief complaint of acute onset dysphagia and generalized weakness. The horse had a history of being mildly lethargic and uncomfortable the day prior to presentation. The evaluation by the primary veterinarian noted discharge containing feed material coming from both nostrils. After ruling out choke, acute onset dysphagia was diagnosed via endoscopy, and the primary veterinarian immediately referred the horse to Cornell. On presentation, the patient continued to be dysphagic and was mildly tachycardic. It had a decreased tongue tone, decreased tail tone, and generalized muscle weakness and muscle fasciculations. The problem was determined to be neuromuscular weakness most likely due to botulism. This paper will discuss the presentation, possible differentials, diagnosis, treatment and prognosis of botulism in equine patients.