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A nationwide outbreak of a respiratory virus last fall sent droves of children to emergency departments. The infections have now subsided, as researchers knew they would, but they have left behind a frightening mystery. Since August, 103 children in 34 states have had an unexplained, poliolike paralysis of an arm or leg. Each week, roughly three new cases of so-called acute flaccid myelitis are still reported to the Centers for Disease Control and Prevention.

This flipped case study explores how the topics of membrane structure, transport, and signaling via membrane-bound receptors are intimately associated with the paralysis of muscle targeted by botulinum neurotoxin. The case scenario revolves around a fictitious socialite that has requested the assistance of her personal concierge physician with a condition that has developed after having participated in a Hamptons Botox party. The physician and a shadowing pre-med undergraduate chat about the molecular mechanisms behind Botox induced muscle paralysis. The case is designed as an engaging capstone exercise for students to gain appreciation for how knowledge of basic cellular and molecular biology mechanisms are essential for pharmaceutical development and medical patient diagnosis and prognosis. Written for an undergraduate general biology course, the case is also suitable for use in courses such as cellular biology, neurobiology, or human physiology.