Botulinum toxin A
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Jaundice and abnormal hepatic function after intravesicular injection: case report A 59-year-old woman experienced jaundice and abnormal hepatic function after receiving intravesicular botulinum toxin A. The woman presented 5 days after her third intravesical botulinum toxin A instillation of 200IU, mixed with 20mL of 0.9% saline, injected into 20 sites in the bladder sparing the trigone (10IU per site) for the treatment of detrusor overactivity. At presentation, she reported a 2-day history of spasmodic right upper quadrant pain and jaundice, as well as nausea, vomiting, dark urine and pale loose stools. Mild icterus was observed. She reported having similar but less severe episodes after her two previous botulinum toxin A treatments. She presented to an Emergency Department 2 days after her second botulin toxin A injection, and was discharged following normal blood test results and a normal abdominal ultrasound. Blood tests at her third presentation indicated abnormal liver function and a liver biopsy showed mild hepatocellular steatosis with the appearance of chronic active/lobular hepatitis. The woman received steroid treatment and her jaundice improved over about 3 weeks. Her liver function tests normalised within 3 months. Author comment: "We present a case of jaundice following intravesical [botulinum toxin A] injection." Marri RR, et al. Jaundice following intravesical botulinum toxin - a previously unreported complication. [Review]. BMJ Case Reports 2010: Jan 2010. Available from: URL: http://dx.doi.org/10.1136/bcr.04.2010.2881 - United 803085794 Kingdom
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Reactions 20 Apr 2013 No. 1448
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