NECROTIZING FASCIITIS AS A COMPLICATION OF BOTULINUM TOXIN INJECTION

Purpose To highlight the need for early diagnosis and treatment of the rare condition of necrotising fasciitis as a complication of botulinu m toxin injection, and to illustrate that injections in immunocompromi sed patients carry a rare but serious risk. Results and methods A case report is presented of an 80-year-old woman suffering from blepharosp asm and chronic myeloid leukaemia, who developed necrotising fasciitis 3 days after a botulinum toxin injection. Conclusions Chronic debilit ating processes such as diabetes, alcoholism and polymyositis have bee n suggested as predisposing factors in the development of necrotising fasciitis. We believe this is the first reported case of necrotising f asciitis occurring secondary to a botulinum toxin injection. The fact that this infection extended through the fascial planes and led to the death of muscle was, probably, because an inoculum was introduced dir ectly into the muscle at the time of botulinum toxin treatment. This m ay have led to its deep spread and difficulty in debriding the area. C hronic myeloid leukaemia does not in itself cause significant immunosu ppression, but our patient was on anti-proliferative treatment and had a low leucocyte count, which may have been a predisposing factor in t his case.