Iatrogenic Botulism in a Child With Spastic Quadriparesis

Abstract

Botulinum toxins are potent neurotoxins used in a variety of neurological disorders. Few pediatric reports have been published to date regarding the potential hazards of therapeutic use of botulinum toxins. We describe the case of a 10-year-old boy who developed systemic weakness following treatment of spasticity with botulinum toxin type B. The patient developed iatrogenic botulism with ptosis, facial diplegia, neck flexor and extensor weakness, and profound hypopharyngeal laxity with respiratory compromise from which he eventually recovered. Clinicians should be mindful of the risk for systemic botulism when using local injections of the neurotoxin.

Serious and Long-Term Adverse Events Associated with the Therapeutic and Cosmetic Use of Botulinum Toxin

“…The serious adverse events identified in case reports varied from idiosyncratic adverse reactions like anaphylactic shock to dose-dependent adverse reactions like cervical kyphosis and botulism [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38]. They were attributed to various types and preparations of botulinum toxin.…”

“…In addition, botulism-like generalized weakness has been reported in a patient treated for axillary and palmar hyperhidrosis [12]. Serious adverse events related to the therapeutic use of botulinum toxin include severe velopharyngeal insufficiency, brachial plexopathy, remote muscle weakness, botulism-like generalized muscle weakness, necrotizing fasciitis, crisis of myasthenia, generalized paralysis, marked bilateral blepharoptosis, impairment of speech and chewing, Guillain-Barré syndrome, severe dysphagia, iatrogenic botulism, generalized skin rash, aspiration pneumonia, unilateral facial madarosis and alopecia, and palatal palsy [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38]. It is interesting that one of the patients presented with generalized weakness 5 years after continued use of botulinum toxin [19].…”

Сучасна Діагностика Та Лікування Хворих На Ботулізм

“…• Застосування ботулотоксину з терапевтичною або косметичною метою. Рідкісні випадки ятрогенного ботулізму були зафіксовані у дітей після терапевтичного застосування токсину типу В при лікуванні спастичних тетрапарезів [24] і використанні токсину типу А з метою зменшення дистонії, пов'язаної з церебральним паралічем [25]. Крім того, випадки ятрогенного ботулізму були зафіксовані при застосуванні ботулотоксину типу А з косметичною метою [26].…”

Botulinum Neurotoxin: The Ugly Duckling

“…One serious argument is based on several reports and unconfirmed rumors about many (about 180) adverse effects including 16 deaths related to botulinum toxin types A and B in clinical treatment [97, 98]. Since no one may ignore the risks of every medical intervention, some serious complications might be expected after botulinum neurotoxin injection, but they are usually attributed to iatrogenic reasons and/or to underlying neuromuscular disorders [99]. …”