Delayed Antitoxin Treatment of Two Adult Patients with Botulism after Cosmetic Injection of Botulinum Type A Toxin.
BACKGROUND
Injection of botulinum toxin type A for cosmetic purposes is common. It is believed to be safe, but adverse reactions have been reported, including dysphagia, generalized paralysis, respiratory depression, and death caused by focal injection of the toxin. Early administration of antitoxin in patients with adverse reactions is the mainstay of management, but the time window for its clinical efficacy is not well defined.


METHODS
Two female adult patients with clinical botulism after botulinum toxin type A injection are described. Both patients had received intramuscular injection of botulinum toxin type A in their calves at beauty shops for cosmetic reasons. They developed clinical botulism about 3 days postinjection. They presented late to the emergency department. Monovalent type A botulinum antitoxin was administered 7 and 9 days from symptom onset, respectively. Both patients showed clinical improvement after the antitoxin treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients may present to the emergency department with systemic effects of botulinum toxin type A after cosmetic injection. Clinical efficacy of botulinum antitoxin treatment was observed in two patients who were given the drug 7 and 9 days after the occurrence of symptoms of botulism after cosmetic injection of botulinum toxin type A. It may be worthwhile to commence antitoxin treatment even if patients present late.
Accident and Emergency Department, Hong Kong University-Shenzhen Hospital, Shenzhen, China.
Kit-Ling
KL
Fan
Accident and Emergency Department, Hong Kong University-Shenzhen Hospital, Shenzhen, China.
Yan-Li
YL
Wang
Accident and Emergency Department, Hong Kong University-Shenzhen Hospital, Shenzhen, China.
Gary
G
Chu
Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Ling-Pong
LP
Leung
D000328:Adult; D001904:Botulinum Antitoxin / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000009:adverse effects*; D001906:Botulism / Q000188:drug therapy* / Q000209:etiology; D003357:Cosmetic Techniques / Q000009:adverse effects; D003680:Deglutition Disorders / Q000139:chemically induced; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D018908:Muscle Weakness / Q000139:chemically induced; D009465:Neuromuscular Agents / Q000009:adverse effects*; D013064:Speech Disorders / Q000139:chemically induced; D061665:Time-to-Treatment
D001904:Botulinum Antitoxin; D007155:Immunologic Factors; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
antitoxin; botulism; iatrogenic