Self-Administered Botulinum Toxin from Unauthorized Sources Can Trigger Severe Illness

Clinical Takeaway

: When a patient presents with respiratory or neurologic difficulties after self-administering botulinum neurotoxin, the CDC should be consulted immediately and use of botulinum antitoxin considered.

Context

Botulinum neurotoxin (BoNT) has long been used as a cosmetic treatment for wrinkles, with FDA-monitored purification and administration through authorized providers. Even so, paralytic effects can occur — sometimes long after BoNT delivery.

Key Results

From May through June of 2025, the CDC received reports of three cases of severe illness among women (age range, 29–59) in New York, Texas, and Wisconsin following self-injection of BoNT in the neck, face, or both. The neurotoxin had been acquired through social media from unknown sources in Asia. Presentations included respiratory difficulties, dysphagia, dysarthria, diplopia, ptosis, and upper-extremity weakness. All the women were hospitalized for 3 to 6 days; one required mechanical …

Reviewing Author

Stephen G. Baum, M.D.

Disclosures

Consultant/Advisory BoardClinical Infectious Diseases

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