Highlights of serious distant effects after local injection of botulinum toxin therapy: A report of pediatric case

Eman Abdelfatah Mohammed,Hoda M Salah Eldin

doi:10.5348/101127z01em2020cr

Abstract

Introduction: Botulinum neurotoxin A (BoNT-A) is widely used in various conditions that cause involuntary muscle contractions, such as management of spasticity in cerebral palsy (CP). However, iatrogenic botulism resulting from systemic effects from BoNT-A is uncommon but may have serious life-threatening consequences. Case Report: We report a case of pediatric patient who developed iatrogenic botulism after therapeutic intramuscular injections of BoNT-A. Conclusion: This case highlights the importance of clinicians having adequate information of the risk of systemic botulism following local injections of BoNT-A and caution is needed in using this therapy.

Highlights

Botulinum neurotoxin A (BoNT-A) is widely used in various conditions that cause involuntary muscle contractions, such as management of spasticity in cerebral palsy (CP)
Botulinum neurotoxins when injected locally into the muscle act at the neuromuscular junction resulting in dose-dependent muscle paralysis [3]
We describe a case of a child with CP who developed iatrogenic botulism after injections of therapeutic doses of botulinum toxin for lower limb spasticity

Summary

INTRODUCTION

Paralytic illness produced by neurotoxin of Clostridium botulinum, an anaerobic, spore-forming bacterium [1]. Botulinum neurotoxins when injected locally into the muscle act at the neuromuscular junction resulting in dose-dependent muscle paralysis [3]. It causes reversible muscle weakness and inhibits acetylcholine release for about three months [5]. Details of the adverse effects and deaths following treatment with BoNT-A in children with CP are limited. We describe a case of a child with CP who developed iatrogenic botulism after injections of therapeutic doses of botulinum toxin for lower limb spasticity. A 5-year-old male child with CP presented with botulism-like manifestations 10 days after receiving multilevel injections, total dose of 500 units of BoNT-A (Dysport®) in his lower limbs to relieve muscle spasticity. The symptoms were gradually resolved on subsequent follow-up visits and completely recovered in two months

DISCUSSION

CONCLUSION