Clinical characteristics of botulinum toxin poisoning following cosmetic injections

Botulinum toxin, a protein exotoxin secreted by Clostridium botulinum, binds to peripheral nerve terminals, inhibits acetylcholine release, and leads to flaccid muscle paralysis. [1]Botox (onabotulinum toxin A) was approved by the Food and Drug Administration (FDA) for cosmetic and therapeutic indications in 2002, and its global use has increased substantially. [2]owever, some unlicensed botulinum toxin products may cause iatrogenic botulism. [3]Early diagnosis remains challenging owing to non-specific clinical features and the lack of diagnostic biomarkers, often delaying the timely administration of antitoxin. [4]This study reviewed recent cases of botulism in our center and summarized their clinical presentations, symptoms, and outcomes.This single-center retrospective study was conducted at the First Affiliated Hospital of Wenzhou Medical University.The medical records of patients with suspected botulism treated between June 11 and December 16, 2024, were reviewed.Patients were excluded if they had confirmed intracranial pathology, peripheral neuropathy of alternative etiology, incomplete clinical records, or were unable to cooperate with physical examination.All participants developed botulism after receiving cosmetic injections of unlicensed, high-concentration botulinum toxin at beauty salons or private residences.Patient data were extracted from medical records and categorized into four groups: (1) demographic information: age, sex, and body mass index (BMI); (2) exposure details: injection sites, dosage, incubation periods, time to consultation, length of hospital stay, and presenting symptoms; (3) treatment information: antitoxin administration, organ support, and adverse