[New cases of botulism after intragastric injection of botulinum toxin]

Two female patients presented to our clinic shortly after one another with visual disturbances, double vision, swallowing difficulties and shortness of breath, a few days after an intragastric injection of botulinum toxin in a clinic in Turkey.The physical examination was unremarkable except for signs of respiratory insufficiency with increased respiratory rate and shortness of breath, especially when lying down; no clear neurological symptoms were found. Imaging showed reduced diaphragmatic mobility. Blood gas analyses showed hypoxemic respiratory insufficiency.The patients were observed as inpatients for a few days without specific therapy and were discharged with regressing symptoms.In March 2023, the Robert Koch Institute, the European Centre for Disease Prevention and Control and the WHO published a report on 87 patients who had received intragastric injections of botulinum toxin in 2 Turkish hospitals with the aim of losing weight and subsequently have developed symptoms of botulism. The current cases presented here draw further attention to the problems of the procedure that is still being carried out and to the risks of botulism.