IntroductionBotulism was first described in the literature in the 1820s after a case series including hundreds of people in a German town affected by sausage poisoning. [1] It is described as a severe neuroparalytic, life-threatening, rare disease caused by the anaerobic and spore-forming bacterium Clostridium botulinum . [1, 2] The exo-neurotoxin produced by the proteolytic Clostridium botulinum and non-proteolytic C. botulinum during their growth in food is potently fatal after consuming only a finite amount of around 30-100 ng. [2] There are generally around seven immunologically recognizable existing neurotoxins, identified from A to G, with types A, B, and E being the most reported. [2] Such neurotoxin, in all its existing forms, preferentially impedes neural transmission by blocking the presynaptic release of acetylcholine at the neuromuscular junction, resulting in a reversible process of muscle fiber denervation, leading to paralysis and muscle atrophy. Botulism occurs in different forms: infantile, foodborne, and wound botulism. [3] Whereas iatrogenic and adult are rare yet recognized adverse effects. [4]Botulinum toxin A (Bix-A) has been utilized clinically in a spectrum of diseases such as spasticity, strabismus, blepharospasms, cervical dystonia, hemifacial spasms, and cosmetically. [3] Its therapeutic effect persists for nearly three months. [3] While it is generally safe and is rarely associated with significant yet life-threatening side effects, such as systemic spread of the botulinum toxin leading to systemic botulism syndrome, [4] We thereby report a patient with iatrogenic diffuse botulism post-therapeutic Botox injection for chronic back pain in a non-authorized center. This report is crucial to highlight such a rare but potentially serious side effect of this treatment and the importance of getting such treatment in authorized centers.
