Taiwan Issues Warning After Online Botox Injection Leads to Hospitalization

Authorities Alert Public to Dangers of Unregulated Cosmetic Procedures Following Botulism Case

Taipei, Taiwan – The Centers for Disease Control (CDC) in Taiwan is cautioning the public about the risks associated with unregulated cosmetic procedures after reporting the island's first case of iatrogenic botulism for 2025. The case involves a woman who was hospitalized following a botox injection administered by an illegal online seller.

According to CDC physician Lin Yung-ching (林詠青), the woman, in her 40s, purchased botulinum toxin (botox) for cosmetic use through an online platform. The seller then visited her home in northern Taiwan in late March to administer the injection in her forehead and cheeks.

“This [route of infection] is different from the more commonly known foodborne botulism cases,” Lin said. He added that the patient developed typical botulism symptoms, including difficulty swallowing, impaired saliva secretion, drooping eyelids, and muscle weakness, approximately three days after the injection.

The patient was admitted to an intensive care unit (ICU) and required a ventilator. While serum and stool tests were negative, the case was classified as probable iatrogenic botulism based on clinical symptoms and epidemiological evidence, according to Lin. The negative test results could be attributed to the delay between the botox injection and sample collection.

CDC spokesperson Lo Yi-chun (羅一鈞) stated that the woman received antitoxin treatment at her own expense, which cost NT$226,480 (US$6,977) for a single vial. Her condition improved after treatment, and she was transferred from the ICU to a general ward.

“If a botulism case is caused by the deliberate injection of botox, patients are allowed to apply for antitoxin treatment, but it must be paid for by the patient themselves,” Lo said. He noted that there have been eight cases of iatrogenic botulism in Taiwan since 2019, all linked to cosmetic procedures.

Lo reminded the public that while botox dosages used for cosmetic or medical purposes are typically far below toxic levels, products from unknown sources can pose serious health risks. He also stated that the seller is suspected of violating several provisions of the Pharmaceutical Affairs Act, including illegal drug importation and sales without a license. Administering the injection at the patient’s home is also likely a violation of the Physicians Act.

Health authorities have begun collecting evidence and reported the case to the police. The CDC is withholding further details, such as the patient's city of residence or nationality, to avoid interfering with the investigation.

Botulism is a severe paralytic illness caused by a nerve toxin produced by the bacterium *Clostridium botulinum*. Naturally occurring cases often result from consuming food contaminated with the toxin, the CDC said.