Abstract / Summary
Iatrogenic botulism is a rare but potentially life-threatening complication of cosmetic botulinum neurotoxin (BoNT) administration.This report describes a 30-year-old woman who developed progressive neurological symptoms following cosmetic BoNT injections during the 2025 outbreak of iatrogenic botulism in England.She initially presented with headache, facial numbness, throat discomfort, and paraesthesia, with reassuring clinical observations and neurological examination.Over the following days, she developed bilateral ptosis, diplopia, dysarthria, dysphagia, dry mouth, and generalized weakness, prompting re-presentation approximately nine days after injection.The evolving ocular and bulbar syndrome following recent BoNT exposure raised clinical suspicion of iatrogenic botulism.Critical care and difficult airway teams were involved, and serial respiratory monitoring, including forced vital capacity assessment, was undertaken.Botulism antitoxin was administered following specialist advice, with subsequent neurological improvement and no progression to respiratory failure.Serum for botulinum toxin testing was obtained only after antitoxin administration, limiting optimal laboratory confirmation.Neurological examination subsequently returned to normal, although residual nausea and reduced oral intake persisted.This case highlights the potential for iatrogenic botulism to evolve after an initially reassuring presentation, the importance of respiratory surveillance in patients with bulbar symptoms, and the need to obtain diagnostic serum before antitoxin administration without delaying clinically indicated treatment.