Chegini Azita
Blood Transfusion Research Centre, High Institute for Research and Education in Transfusion Medicine, Hemmat Highway, Tehran, Iran.
Atheroscler Suppl. 2017 Nov;30:283-285. doi: 10.1016/j.atherosclerosissup.2017.05.016. Epub 2017 May 31.
Botulinum toxin (Botox) injections are used as a cosmetic treatment to decrease wrinkles in face and chin. Being a neurotoxic agent it minimizes muscle activity, while side effects are usually rare. This article subsequently presents one case of these rare effects.
A 30-year-old woman presenting with ptosis, diplopia, dysarthria, dysphagia and muscle weakness was admitted to our hospital. She had no history of disease. For cosmetic reasons, she had three Botox injections during the preceding months. On physical examination, muscle weakness 4/5 (cervical extensor, ocular and pharynx) was detected and a diagnosis of myasthenia gravis was made. Protective artificial ventilation was necessary. As a consequence, eight sessions of 2.5 L volume Therapeutic Plasma Exchange (TPE) were applied using normal saline/albumin as substitute. Due to TPE, her muscle force and clinical condition improved. Artificial ventilation could be stopped.
Clinical symptoms of myasthenia gravis and systemic Botox effects are very similar. This should be taken into consideration during medical history taking. The injection of high doses of Botox (more than 200 units in every injection) or boostering within less than one month is dangerous. (Botox BCC2024). Systemic side effects can be treated using TPE to lower the circulating dose of Botox.
肉毒杆菌毒素（保妥适）注射被用作一种美容治疗手段，以减少面部和下巴的皱纹。作为一种神经毒剂，它能使肌肉活动降至最低，而副作用通常很少见。本文随后介绍了一例这些罕见效应的病例。
一名30岁女性，出现上睑下垂、复视、构音障碍、吞咽困难和肌无力，被收治入院。她无疾病史。出于美容目的，她在之前几个月内接受了三次保妥适注射。体格检查发现肌无力4/5（颈部伸肌、眼部和咽部），并诊断为重症肌无力。需要进行保护性人工通气。因此，使用生理盐水/白蛋白作为替代物进行了8次2.5升容量的治疗性血浆置换（TPE）。由于进行了TPE，她的肌力和临床状况得到改善。人工通气可以停止。
重症肌无力的临床症状与全身性肉毒杆菌毒素效应非常相似。在病史采集过程中应考虑到这一点。注射高剂量的肉毒杆菌毒素（每次注射超过200单位）或在不到一个月内进行加强注射是危险的。（保妥适BCC2024）。全身性副作用可以通过TPE治疗以降低循环中的肉毒杆菌毒素剂量。
