Several conditions should be considered in the differential diagnosis, such as: snake bites, spider envenomation, poisoning caused by cholinesterase inhibitors, neuroleptic drug overdose, Guillain–Barré syndrome, tetanus, poliomyelitis, botulism, myasthenia gravis, encephalitis, meningitis, subdural hematoma and diphtheria [49]. The gene discussed is BCHE; the disease is poliomyelitis.