Iatrogenic botulinum toxin poisoning misdiagnosed as myasthenia gravis
10.3760/cma.j.issn.1008-5734.2018.04.016
- VernacularTitle:医源性肉毒素中毒误诊重症肌无力
- Author:
Liuqing WANG
1
;
Yuelan XIAO
;
Shoucheng ZHANG
;
Hong WANG
Author Information
1. 211300,南京市高淳人民医院神经内科
- Publication Type:Journal Article
- Keywords:
Botulism;
Iatrogenic disease;
Diagnostic errors;
Myasthenia gravis
- From:
Adverse Drug Reactions Journal
2018;20(4):311-312
- CountryChina
- Language:Chinese
-
Abstract:
A 26-year-old female patient received injections of botulinum toxin in a private clinic for cosmetology. One hundred units of botulinum toxin were injected firstly into the mandible,and then 200 units were injected into each gastrocnemius 14 days later. On day 2 after the second injection,the patient suffered from fatigue and oppression in chest,which did not affect her daily life. Above-mentioned symptoms aggravated 3 weeks later and even difficulty in walking and limbs lifting,bucking in drinking,and bilateral blepharoptosis appeared. She was admitted to hospital 4 weeks after the onset of the disease. Physical examination showed that the patient had bilateral blepharoptosis,difficulty in head-raising,grade 4,5,and 3 muscle strength respectively in the proximal limbs,distal limbs,and lower extremities,and unable to stand up after squatting. Myasthenia gravis was considered. However,results of the prostigmin test and repetitive electrical nerve stimulation test did not support above diagnosis. Swelling in the patient's lower jaw was found during the doctor's regular ward rounds on day 4 after the admission and the diagnosis of botulinum toxin poisoning was confirmed by inquiring the history of disease. After 12 days of symptomatic treatments,the patient's weakness of limbs and oppression in chest relieved,bilateral blepharoptosis markedly improved,and her muscle strength returned to normal basically.
