Bilinmeyen Formülasyonlu Toksinle İyatrojenik Botulizm Vakası

Year 2025, Volume: 20 Issue: 3, 241 - 243

Fatih Koçtürk

https://doi.org/10.17517/ksutfd.1529304

Abstract

Tüm serotipler, nöromüsküler kavşakta temel nörotransmitter asetilkolinin salınımını bloke ederek kas felcine neden olur. Kozmetolojik uygulamalar yüz, çene, boyun ve göğüs bölgesindeki çizgi, kırışıklık ve kırışıklıkların düzeltilmesinden, hiperhidroz gibi dermatolojik uygulamalara kadar pek çok uygulamayı içermektedir. Botulinum toksini enjeksiyonları genellikle iyi tolere edilir ve çok az yan etkisi vardır. Biz burada dış klinikte alın ve koltuk altı botoks tedavisinden etkilenen botulizm olgusunu sunuyoruz; 10 gün sonra terleme nedeniyle ayak tabanlarına botoks uygulandı. Son 2 gündür şikayetleri artan hasta bu şikayetlerle acil servisimize başvurdu. İyatrojenik botulizm ön tanısıyla nöroloji kliniğine başvuran ve son çalışmalarda bildirilen vitalleri stabil olan hastada, iki farklı dozda onabotulinum toksininin terapötik dozlarının intramüsküler enjeksiyonu sonrasında botulizme benzer bir sendrom geliştiği bildirildi. İlk hastada bu semptomlar yalnızca bir dozdan sonra ortaya çıkarken, ikinci hastada toksinin beş yıllık düzenli tedavisinden sonra ortaya çıktı. Ekstraoküler, bulber, gövde ve ekstremite kaslarında klinik olarak tespit edilebilir güçsüzlük mevcuttu ve test edilen tüm kaslarda EMG değişiklikleri kaydedildi. Kas zayıflığı ve EMG değişiklikleri birkaç hafta sonra düzeldi.

Keywords

iyatrojenik botulizm , botulinum toksin

A Case of Iatrogenic Botulism with a Toxin of Unknown Formulation

Abstract

All serotypes block the release of the essential neurotransmitter acetylcholine at the neuromuscular junction, causing muscle paralysis. Cosmetological applications include a range of treatments, from correcting lines, wrinkles, and creases on the face, chin, neck, and chest area to dermatological applications such as hyperhidrosis. Botulinum toxin injections are generally well-tolerated and have few side effects. We present a case of botulism that was affected by Botox treatment of the forehead and axillae in an external clinic. Ten days later, Botox was administered to the soles of the feet for sweating. The patient, whose complaints had increased over the past 2 days, contacted our emergency department with these complaints. The patient, who was admitted to the neurology clinic with the preliminary diagnosis of iatrogenic botulism and whose vitals were stable the patients reported in the recent studies developed a syndrome similar to botulism after intramuscular injections of therapeutic doses of onabotulinum toxin derived from two different batches of the drug. In the first patient, these symptoms occurred after only one dose, while in the second patient, they occurred after five years of regular treatment with the toxin. Clinically detectable weakness was present in the extraocular, bulbar, trunk, and limb muscles, and EMG changes were recorded in all muscles tested. The muscle weakness and EMG changes resolved a few weeks later.

Keywords

iatrogenic botulism , toxin , botulinum toxin

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