Abstract
Botulinum toxin (BoNT) is a potent neurotoxin with broad applications in medicine and cosmetics. Cases of botulism toxicity from aesthetic injections have been spiking in recent months across the United States. Here, we present a patient who presented with bulbar paralysis and increasing respiratory distress following BoNT injections performed at her home by an unlicensed aesthetician. The patient presented with ptosis, dysphagia, dysarthria, shortness of breath, and proximal muscle weakness. The patient was given botulism antitoxin and showed marked improvement in the following days. The pathophysiology of iatrogenic botulism is unknown but may be due to improper injections with large doses or direct injection into the bloodstream. Counterfeit BoNT injections have been reported and may include unsafe components or dangerous levels of BoNT that surpass the therapeutic dose.