摘要：
1例26岁女性患者因美容需求在私人诊所于下颌部注射肉毒素100 U,14 d后又在双侧小腿各注射肉毒素200 U.第2次注射后次日患者出现全身乏力,胸闷,但不影响日常生活.3周后症状加重,行走费力,双上肢抬举困难,并出现胸闷、饮水呛咳、双上睑下垂等症状.发病4周后入院,体检见双侧上睑下垂,抬头困难,双上肢近端肌力4级、远端肌力5－级,双下肢肌力3级,蹲下后无法起立,考虑为重症肌无力.但入院后新斯的明试验和重复神经电刺激检查结果均不支持重症肌无力的诊断.入院第4天医师查房时见患者下颌处有肿胀,经追问病史,明确肉毒素中毒诊断.给予营养神经等对症处理12 d后,患者四肢乏力、胸闷等症状缓解,双上睑下垂明显好转,肌力基本恢复正常.%A 26-year-old female patient received injections of botulinum toxin in a private clinic for cosmetology. One hundred units of botulinum toxin were injected firstly into the mandible,and then 200 units were injected into each gastrocnemius 14 days later. On day 2 after the second injection,the patient suffered from fatigue and oppression in chest,which did not affect her daily life. Above-mentioned symptoms aggravated 3 weeks later and even difficulty in walking and limbs lifting,bucking in drinking,and bilateral blepharoptosis appeared. She was admitted to hospital 4 weeks after the onset of the disease. Physical examination showed that the patient had bilateral blepharoptosis,difficulty in head-raising,grade 4,5,and 3 muscle strength respectively in the proximal limbs,distal limbs,and lower extremities,and unable to stand up after squatting. Myasthenia gravis was considered. However,results of the prostigmin test and repetitive electrical nerve stimulation test did not support above diagnosis. Swelling in the patient's lower jaw was found during the doctor's regular ward rounds on day 4 after the admission and the diagnosis of botulinum toxin poisoning was confirmed by inquiring the history of disease. After 12 days of symptomatic treatments,the patient's weakness of limbs and oppression in chest relieved,bilateral blepharoptosis markedly improved,and her muscle strength returned to normal basically.
