A sixteen year old Andalusian gelding presented to Cornell University in the summer of 2016 with signs of weakness and recumbency. He presented down on the trailer and had a physical exam consistent with diffuse neuromuscular weakness. He was presumptively treated for botulism. Botulism is a toxicity of the neuromuscular junctions due to depletion of acetylcholine. The patient became progressively weaker, even after administration of the botulinum antitoxin and euthanasia was elected due to his grave prognosis. It has been found that less than 20% of botulism cases that are recumbent on presentation or have an abnormal respiratory effort survive to discharge.