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Misuse of botulinum toxin is potentially lethal

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39052.446597.DE (Published 07 December 2006) Cite this as: BMJ 2006;333:1212

The purified toxin of Clostridium botulinum is widely used for cosmetic purposes and seems to be safe if used correctly. Only four cases of botulism have been reported to the US authorities so far, and they were the result of criminal misuse of a highly concentrated preparation that was never intended for humans.

The cluster of cases came to light late in 2004 when two people presented to hospital with symptoms and signs of botulism. The source was traced to a cosmetic clinic where one of the cases, a doctor, had injected himself and three others with 20-40 times the lethal dose of botulinum toxin to help smooth out their facial wrinkles. Despite receiving timely treatment with antitoxin, all four spent the next few weeks being ventilated. The doctor was the worst affected. He spent more than three months in hospital and needed respiratory support for more than five months.

A criminal investigation followed, and the doctor, who was practising without a licence, pleaded guilty to a federal charge of rebranding a drug and got three years in prison. The vial he used was ordered from a legitimate manufacturer, and was clearly labelled for research purposes only. It contained enough toxin to kill more than 14 000 people.

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