Here we report the consumption of traditional cottage cheese (Koupé) in western Iran, as a new way of transmission of botulism. All the patients (a nine member family) had at least two specific symptoms of botulism. Given the clinical symptoms and contact history, anti-toxins were injected in the early hours of hospital admission. On Jan 27, 2017, three patients clinically suspected of foodborne botulism were referred to the hospital in Sanandaj, western Iran from their local hospital in Baneh, western, Iran. Because of the worsening of clinical conditions, a 34-yr-old man with both gastrointestinal and neurological symptoms was admitted to the ICU, while other family members were treated in the infectious diseases ward of the hospital. The disease was diagnosed through isolating toxin A from the cheese and testing the serum sample of one of the patients. This case of botulism showed that traditional Koupé cheese could cause foodborne botulism. Hence, it is necessary to train and inform people about how to process and keep the cheese to prevent similar cases.
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