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Article
June 17, 1992

The Lethal Botulinum Toxic Shot Syndrome

Author Affiliations

Wake Forest University Medical Center Winston-Salem, NC

JAMA. 1992;267(23):3149. doi:10.1001/jama.1992.03480230041009
Abstract

To the Editor.  —We describe an unexpected fatality that was a secondary consequence from the administration of therapeutic botulinum toxin.

Report of a Case.  —A 55-year-old alcoholic man with severe, refractory retrocollis complained that he could not look straight ahead while walking or sitting. Physical examination revealed hypertrophy of cervical muscles and such severe involuntary neck extension that he indeed walked and sat looking up.At his return visit, the patient was intoxicated. Using electromyogram needle guidance to identify the responsible posterior cervical muscles,1 we injected them with 200 U of botulinum toxin. Within 2 weeks, he improved markedly and could look straight ahead without assistance.He missed his return appointment. Treatment had enabled him to aim and use a gun. His wife told us that 10 weeks after the injections, while drinking, he argued with and then fatally shot his adult son. Six weeks later, escorted by prison

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