DPH Probes suspected Botox-linked botulism cases in Massachusetts

The Massachusetts Department of Public Health (DPH) is investigating four recent cases of suspect botulism linked to cosmetic botulinum toxin (Botox) injections in the South Shore area. These cases highlight the risk of iatrogenic botulism, a rare but serious adverse event resulting from the administration of botulinum toxin products.

Botulinum toxin (Botox) is widely used for cosmetic purposes to reduce wrinkles and fine lines. While generally safe when administered by trained professionals, improper dosing, administration technique, or use of non-FDA-approved products may increase the risk of systemic botulism symptoms. Botulism is a rare and sometimes fatal disease caused by botulinum toxin circulating in the blood and producing effects remotely from the injection site. There may be symptom overlap
between the presentation of localized adverse effects from injection of botulinum toxin, especially in the head and neck, and the early symptoms of botulism.

Symptoms consistent with botulism occurring after botulinum toxin injections. Initial botulism symptoms may include double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, and difficulty breathing. These symptoms may be followed by a descending, symmetric muscle weakness that progresses over hours to days.

Common findings include:

• Muscle weakness, especially in areas beyond the injection site. Note
  especially symmetric or bilateral weakness in distinction to localized
  weakness at or near the injection site, which is expected.
• Dysphagia (difficulty swallowing)
• Dysarthria (speech difficulties)
• Ptosis (drooping eyelids)
• Respiratory difficulty
• Other cranial nerve palsies

Symptoms may develop from hours to days post-injection. Contact your health care provider if you are experiencing symptoms after recently receiving Botox injections.

For additional information or questions, please contact the Massachusetts Department of Public Health, at 617-983-6800