OnabotulinumtoxinA Unmasking Myasthenia Gravis

Glick, Zoey R.; Vaphiades, Michael S.; Northington, Marian

doi:10.1111/dsu.12022

Cited by 8 publications

(5 citation statements)

References 3 publications

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“…To our knowledge, this patient is the 8th case reported in the literature of latent MG, revealed by BoNT-A injection [7, 8, 9, 10, 11, 12, 13, 14], and the most documented case from an electrophysiological point of view. These different cases are listed in Table 1.…”

Section: Discussionmentioning

confidence: 91%

Cosmetic Injection of Botulinum Toxin Unmasking Subclinical Myasthenia Gravis: A Case Report and Literature Review

et al. 2019

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Cosmetic or therapeutic use of botulinum toxin type A (BoNT-A) is usually safe but can rarely cause iatrogenic botulism. Iatrogenic botulism and myasthenia gravis (MG) share similar clinical features, because both BoNT-A and anti-acetylcholine receptorantibodies impair neuromuscular transmission. We report a patient who underwent cosmetic BoNT-A injection and later developed serious local and systemic adverse reactions. The peculiarity of this case is that a latent seropositive MG was eventually discovered, suggesting that both iatrogenic botulism and MG contributed to the clinical picture. This patient is one of the less than 10 reported cases worldwide in whom MG was unmasked by BoNT-A injection. He is the first to be assessed in detail by single-fiber electromyography. This case emphasizes the risk associated with BoNT-A injection in patients with subclinical impairment of neuromuscular transmission and prompts the search for MG in case of exaggerated response.

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Section: Discussionmentioning

confidence: 91%

Cosmetic Injection of Botulinum Toxin Unmasking Subclinical Myasthenia Gravis: A Case Report and Literature Review

et al. 2019

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“…The questioning of the application of BoNT-A, especially in patients presenting with these symptoms and neurological findings, should be added to our routine check in the patient's anamnesis. On the other hand, it is reported that the use of BoNT-A may cause aggravation and should be diagnosed in patients with subclinical myasthenia gravis [3,22,25,26].…”

Section: Clinical Featuresmentioning

confidence: 99%

Iatrogenic botulism cases after gastric and axillary application of botulinum toxin and review of literature

Eser,

Hasanoğlu,

Kayaaslan

et al. 2024

J Infect Dev Ctries

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Introduction: Iatrogenic botulism is a rare, serious disease that progresses with descending paralysis and develops after cosmetic or therapeutic botulinum toxin-A (BoNT-A) application. Case presentations: In this case series; six cases of iatrogenic botulism followed up in our center are presented. Four of these developed after gastric BoNT-A and two after axillary BoNT-A application. Results: The most important cause for the disease was the use of unlicensed products and high-dose toxin applications. The first symptoms were blurred vision, double vision, difficulty in swallowing, and hoarseness. Symptoms appeared within 4-10 days after the application of BoNT-A. Symptoms progressed in the course of descending paralysis in the following days with fatigue, weakness in extremities and respiratory distress. Diagnosis was based on patient history and clinical findings. The main principles of foodborne botulism therapy were applied in the treatment of iatrogenic botulism. If clinical worsening continued, regardless of the time elapsed after BoNT-A application, the use of botulinum antitoxin made a significant contribution to clinical improvement and was recommended. Conclusions: Routine and new indications for BoNT-A usage are increasing and, as a result, cases of iatrogenic botulism will be encountered more frequently. Physicians should be alert for iatrogenic botulism in the follow-up after BoNT-A applications and in the differential diagnosis of neurological diseases that are presented with similar findings.

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“…They hypothesized that the patient's immunosuppression with methotrexate allowed her to tolerate lower doses. 8 The second case was described by Azita Chegini in 2017: she described a 30-year-old woman presenting with blepharoptosis, diplopia, dysarthria, dysphagia, respiratory distress and muscle weakness after three times BTA injections during the previous months. Electromyography and laboratory tests confirmed the diagnosis of MG.…”

Section: Do Not Forget About Myasthenia Gravis When Performing Botuli...mentioning

confidence: 99%

Do not forget about myasthenia gravis when performing botulinum toxin injections

Dell'Antonia

Mugheddu

Ferreli

et al. 2023

Acad Dermatol Venereol

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OnabotulinumtoxinA Unmasking Myasthenia Gravis

Cited by 8 publications

References 3 publications

Cosmetic Injection of Botulinum Toxin Unmasking Subclinical Myasthenia Gravis: A Case Report and Literature Review

Cosmetic Injection of Botulinum Toxin Unmasking Subclinical Myasthenia Gravis: A Case Report and Literature Review

Iatrogenic botulism cases after gastric and axillary application of botulinum toxin and review of literature

Do not forget about myasthenia gravis when performing botulinum toxin injections

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