A REPORT OF FACIAL PALSY IN KAWASAKI SYNDROME

Facial nerve palsy is a very rare complication of Kawasaki syndrome and has been reported in only 25 patients world-wide. None of the 25 previous reported cases with this complication were treated with IV immunoglobulin. We treated a 2-year old boy with bilateral coronary artery aneurysms due to Kawasaki syndrome. In our patient, the duration of disease was 7 to 9 days. He developed a marked unlilateral peripheral fascial nerve pulsy on the third day of his illness and was treated with aspirin (80 mg/Kg) and gamma globulin (2 g/Kg), which resulted in complete resolution of facial nerve palsy within 48 hours. Review of pervious cases demonstrates that children with Kawasaki–associated facial nerve palsy have more than twice the risk for coronary artery aneurysm (52% vs 25%) as compared with children without facial nerve palsy. Unexplained facial nerve palsy in young children with a prolonged febrile illness should provoke consideration of Kawasaki syndrome and dictates taking an echocardiography to exclude coronary artery aneurysms. Although facial nerve palsy appears likely to be resolved in all patients surviving the acute phase of Kawasaki syndrome, treatment with IVIG appears to shorten considerably the time for full recovery and provides an important clue to the underlying mechanism of neurological injury in this illness.