• So Young Kwon, Eun Hwa Jun, Seong Jin Park, and Yumi Kim.
• Department of Anesthesiology and Pain Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea.
• Medicine (Baltimore). 2022 Oct 21; 101 (42): e30950e30950.

RationalePiriformis syndrome (PS) is neuromuscular disorder caused by sciatic nerve compression by piriformis muscle and related to sciatic-type pain. When the conservative care fails, local injection or surgery can be also performed into piriformis. In recent years, botulinum toxin (BoNT) has also been considered as a new therapeutic option of piriformis syndrome.Patient ConcernsA man in his late 40s came to pain clinic for left low back pain. The symptom was aggravated with sitting position.DiagnosisPiriformis syndrome.InterventionsThe patient underwent BoNT injection with 100 IU with 2 mL into piriformis muscle for piriformis syndrome treatment, and his pain was relieved. However, it recurred 8 months later. BoNT injection was repeated with 100 IU with 5 mL.OutcomesAt the time of this writing, his pain was reduced for 2 years without any medication.LessonsWe report a case of treating relapsed piriformis syndrome with BoNT injection of different dilution volume, suggesting that the higher the dilution volume, the more effective for therapeutic effect of BoNT.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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