title: Necrotising fasciitis as a complication of botulinum toxin injection.
abstract: OBJECTIVE
  To highlight the need for early diagnosis and treatment of the rare condition of necrotising fasciitis as a complication of botulinum toxin injection, and to illustrate that injections in immunocompromised patients carry a rare but serious risk.
  
  
  RESULTS
  A case report is presented of an 80-year-old woman suffering from blepharospasm and chronic myeloid leukaemia, who developed necrotising fasciitis 3 days after a botulinum toxin injection.
  
  
  CONCLUSIONS
  Chronic debilitating processes such as diabetes, alcoholism and polymyositis have been suggested as predisposing factors in the development of necrotising fasciitis. We believe this is the first reported case of necrotising fasciitis occurring secondary to a botulinum toxin injection. The fact that this infection extended through the fascial planes and led to the death of muscle was, probably, because an inoculum was introduced directly into the muscle at the time of botulinum toxin treatment. This may have led to its deep spread and difficulty in debriding the area. Chronic myeloid leukaemia does not in itself cause significant immunosuppression, but our patient was on anti-proliferative treatment and had a low leucocyte count, which may have been a predisposing factor in this case.
authors.affiliation: Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: P R
authors.initials: PR
authors.lastname: Latimer
authors.forename: P R
authors.initials: PR
authors.lastname: Hodgkins
authors.forename: A N
authors.initials: AN
authors.lastname: Vakalis
authors.forename: R E
authors.initials: RE
authors.lastname: Butler
authors.forename: A R
authors.initials: AR
authors.lastname: Evans
authors.forename: G A
authors.initials: GA
authors.lastname: Zaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018726:Anti-Dyskinesia Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001764:Blepharospasm / Q000628:therapy; D001905:Botulinum Toxins / Q000009:adverse effects* / Q000627:therapeutic use; D019115:Fasciitis, Necrotizing / Q000209:etiology* / Q000276:immunology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007279:Injections, Subcutaneous; D015466:Leukemia, Myeloid, Chronic-Phase / Q000276:immunology
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins