Diagnosis and treatment of injection-induced botulism:a report of 15 cases and literature review

ZHANG Dan; REN Sihang; CHEN Si; WU Yi; ZHAO Muxin

doi:10.3969/j.issn.1673-7040.2025.10.013

Abstract：Objective To investigate the clinical features,diagnosis,treatment,and outcomes of patients with injection-induced botulism,and to provide evidence for standardizing its clinical management.Methods From January 2024 to January 2025,a retrospec-tive analysis was conducted on the clinical data of 15 patients with injection-induced botulism admitted to the Second Affiliated Hospital of Dalian Medical University.The clinical manifestations,auxiliary examination results,treatment plans,and prognosis of these patients were summarized.Results All 15 patients received illegal botulinum toxin injections at non-medical facilities,among whom 3 had mild poisoning,10 had moderate poisoning,and 2 had severe poisoning.All patients were given symptomatic supportive treatment and injections of botulinum antitoxin type A(4.0 ml/10 000 IU).Their poisoning symptoms were all improved,and no deaths occurred.Eight patients de-veloped serum sickness reactions after antitoxin injection,manifested as erythema,induration,pruritus,pain and increased skin tempera-ture at the injection site,of which 2 were accompanied by fever.The incidence of complications was 53.33％,and all patients recovered af-ter symptomatic treatment.Conclusion Injection of botulinum toxin from unregulated sources can lead to severe poisoning with diverse clinical manifestations,which may be life-threatening in critical cases.Early initiation of symptomatic support and antitoxin therapy is es-sential to reduce complications and improve prognosis.However,vigilance is warranted against potential complications such as serum sick-ness and hypersensitivity reactions induced by equine-derived antitoxin..