The Hong Kong Centre for Health Protection (CHP) of the Department of Health (DH) is investigating a suspected case of botulism after receiving injections of botulinum toxin in the Mainland, and hence reminded the public that such injections should only be prescribed and performed by registered doctors for appropriate use.

Botulinum toxin Public domain image/Wikim,edia commons
Botulinum toxin
Public domain image/Wikim,edia commons

According to the attending clinician, the female patient, aged 47 with good past health, has developed progressive generalized weakness, dizziness, swallowing difficulty, slurring of speech and shortness of breath since May 21. She attended the Accident and Emergency Department of Caritas Medical Centre (CMC) on May 24 and was admitted for management. She was transferred to the Intensive Care Unit for observation and treatment on May 25 and then back to the general ward in stable condition yesterday (May 26) but was discharged against medical advice this afternoon.

The clinical diagnosis was suspected iatrogenic botulism.

Records of CMC revealed that the patient reported that she had traveled to the Mainland this month and visited a beauty premises where she received injections of botulinum toxin to each leg.

“As the patient has been discharged against medical advice and cannot be reached so far, follow-up on her clinical and exposure histories is under way,” a spokesman for the DH said.

In Hong Kong, botulinum toxin is a pharmaceutical product and must be registered with the Pharmacy and Poisons Board of Hong Kong before it can be supplied in the market. All registered pharmaceutical products must carry a Hong Kong registration number in the format of “HK-XXXXX”. Unregistered pharmaceutical products should not be used as their safety, quality and efficacy are not guaranteed.

“Botulinum toxin can be used for medical purposes, such as treatment of overactive bladder, and cosmetic purposes.

Injections should only be performed by registered doctors,” the spokesman said.

“Due to the weakening of associated muscles, patients receiving the injection may have problems with chewing or even swallowing, speaking or breathing. These problems may happen hours, days or weeks after an injection. In some cases, botulinum toxin may spread and affect other areas away from the injection site, resulting in symptoms including hoarseness, drooping of the eyelids, double vision or blurred vision,” the spokesman said.

The DH urged the public to observe the health advice below before receiving botulinum toxin injections:

* Injections should only be performed by locally registered doctors;
* The cosmetic effects of botulinum toxin after injections are temporary and will gradually disappear;
* Understand the procedure, potential risks and complications before receiving botulinum toxin injections.

Consult a doctor for an informed decision;
* Do not receive an injection in case of a history of allergy to botulinum toxin or infection or inflammation on the injection site;
* Request the full name of the doctor in writing if referred by a beauty service provider to a doctor for the procedure, as well as the professional qualifications and relevant experience of the doctor; and
* If symptoms develop, such as fever or feeling unwell, seek medical attention immediately.