Cardiologia Clínica e Experimental
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An Unusual Etiology for Adult Acute Respiratory Distress Syndrome: Botulinum Toxin Type A

Hasan Hüseyin Gökpınar*

Acute Respiratory Distress Syndrome (ARDS), which is seen in adults and can also be referred to as noncardiogenic pulmonary edema, is a life-threatening complication that is treated with intubation and positive pressure ventilation. It usually occurs in association with various conditions such as pneumonia, aspiration, major trauma, and sepsis. There is a permanent hypoxemia that does not respond to support with an oxygen mask, and since there is an absolute need for intensive care, its main management in the acute period is done in intensive care. Possible etiologies include recent surgery, acute pancreatitis, transfusion with blood products, cases of drowning and smoke inhalation, neurogenic edema, and overdose to some drugs and chemicals. However, a recent case where a patient with Central Pontine Myelinolysis (CPM) developed ARDS after an adequate dose of Botulinum Neurotoxin Type A (BoNTA) application to the gastrocnemius muscle group for spasticity management, suggests a possible new factor in ARDS’s etiological framework. The issue of osmotic imbalance is also noted in different organ regions that intersect the paths of CPM and ARDS through BonTA. BoNTA-associated pulmonary interstitial complication, which is first reported recently in the literature, deserves further examination.