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Background We present a case of systemic botulism that underscores the risks associated with the administration of unregulated botulinum toxin from unlicensed providers.Case A 51-year-old forklift driver presented to a peripheral hospital with bilateral facial weakness. She had received 100 units of facial injections with the product ‘Glowtox’, which ostensibly contains a mixture of botulinum toxin and hyaluronic acid filler, administered by an unlicensed practitioner in the patient’s home. At presentation, she had complete bilateral ptosis, forehead weakness and dysphagia. She was accepted for transfer to Westmead Hospital, but during the 48 hours wait for transport, she developed dysarthria, hypophonia, difficulty clearing airway secretions, and reduced upper limb power. The decision was made to intubate for airway protection. She was assessed after transfer as a likely case of systemic botulism, with a differential diagnosis of unmasked myasthenia gravis. Anti-AChR and anti-MuSK antibodies returned negative. Nerve conduction studies showed widespread low amplitude motor potentials, slow repetitive stimulation showed minimal decrement, and high frequency repetitive stimulation demonstrated incrementation, consistent with a presynaptic neuromuscular junction disorder. The patient was treated with botulinum antitoxin and made a remarkable clinical recovery over weeks. A second patient, who received a lower dose of the same product from the same provider, presented with milder facial and systemic weakness under the Westmead Neurology service and was managed conservatively.Conclusion The administration of unregulated botulinum toxin by unlicensed providers carries a risk of systemic botulism. Early administration of botulinum antitoxin can facilitate a more rapid clinical recovery.