The nation’s first case of poisoning caused by a botulinum toxin injection was reported by toxicologist Yang Chen-chang (楊振昌) at a conference at Taipei Veterans General Hospital (TVGH) yesterday.
Yang, TVGH clinical toxicology and occupational medicine department director, disclosed the case during a lecture on botulism related to cosmetic procedures at this year’s International Conference for Poison Control and Research Development.
The case involved two sisters in their 50s who received botulinum toxin injections in June at an unlicensed workshop that used botulinum products from an unknown source, resulting in botulism symptoms five days later.
The older sister developed unclear speech, a hoarse voice and difficulty swallowing after getting multiple injections in the face. However, she was not diagnosed with botulism when she sought treatment at a clinic, so her condition worsened, and she began experiencing weakness in her limbs and required feeding through a nasogastric tube.
The younger sister only received injections near the eyes, and suffered a sore throat, drooping eyelids and an inability to look upwards.
Yang said the sisters told him that a stranger approached them on the street and claimed he could take them to see a Korean doctor who could provide Botox injections at a discounted price.
The women sought treatment at TVGH in July, three weeks after the injections. Botulism was suspected, so the hospital reported the case to the Centers for Disease Control (CDC), he said.
Yang said doctors suspected the sisters had been injected with excessive doses of botulinum toxin, or that there were problems with the quality of the substance used.
Usually patients suspected of food-borne botulism are immediately given an antitoxin — within 24 hours for the best results, and no later than seven days.
The younger sister’s symptoms gradually resolved, and she recovered in September. However, the elder sister still needed to be fed through a tube, although she improved enough to be able to swallow, he said, adding that serious botulism can result in flaccid paralysis or respiratory failure.
CDC Deputy Director-General Philip Lo (羅一鈞) said the local health department could not locate the person who provided the injections, as the sisters got in a taxi with the man and did not remember where they were taken.
He said that the first case of suspected botulism from a botulinum toxin injection was reported by a woman in her 40s late last year, but the patient received the injection at a clinic in China. The sisters were the first case of botulism caused by injections received in Taiwan.
The CDC said Hong Kong received its first report of suspected poisoning from a botulinum toxin injection in May 2016, and as of November last year, a total of 17 cases had been reported. Eleven of those cases involved people who had received the injections in China.
Lo urged people to carefully choose licensed aesthetic medical clinics for botulinum toxin and other treatments, and to make sure the procedures are implemented by licensed medical practitioners who use products with a legal drug license number.
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