Indian Journal of Pediatrics (January 2024) 91(1):101

https://doi.org/10.1007/s12098-023-04835-y

CORRESPONDENCE

Kawasaki Disease with Facial Nerve Palsy

Yo Murata1,2 · Hiroshi Masuda2 · Shintaro Moroka2 · Nobuyuki Yotani3 · Noriko Morimoto4 · Mitsuru Kubota2 ·
Akira Ishiguro1

Received: 13 June 2023 / Accepted: 8 August 2023 / Published online: 2 September 2023
© The Author(s), under exclusive licence to Dr. K C Chaudhuri Foundation 2023

To the Editor: Facial nerve palsy (FNP) is common in chil-
dren, but is a very rare complication in Kawasaki disease
(KD) [1–3]. We present a patient with FNP associated with
coronary artery lesions (CALs) in KD.
A 4-mo-old Japanese girl without past medical history had
left FNP without any other symptoms two days before admis-
sion. The cause of FNP was unknown at first in a secondary
care hospital. However, her detailed history of present illness
revealed a 4-d episode of fever, conjunctival injection, ery-
thematous rashes, and erythema of the lips, which spontane-
ously resolved 8 d before admission. Due to the history and an
echocardiographic finding of CALs, KD was suspected and
she was transferred to our hospital. C-reactive protein (CRP)
was 22.58 mg/dL on laboratory testing. An echocardiogram
showed right and left CALs (Z-score 11.1 and 4.07) [4]. We
diagnosed FNP with CALs in KD and the patient was started on
intravenous immunoglobulin. We also administered 2 mg/kg/d
of prednisolone and mecobalamin for the treatment of FNP.
After the treatments, FNP completely improved 6 wk after the
onset. CALs were improved somewhat, but remained two years
after onset.
We reviewed the relevant literature to find characteristics of
cases in which FNP led to the diagnosis of KD, as in our case,
and found seven case reports. The median age of onset was 4
mo. In many cases, patients presented with no symptoms or only
fever. High CRP (median 16.25 mg/dL) and CALs were found
in all cases. Our case and literature review indicate that FNP
associated with KD must not be missed because CALs are a
complication with high probability. We should suspect KD as a
cause of FNP and perform an echocardiogram when the patient
with FNP is an infant and detailed history suggests KD or when
CRP level is high.
Declarations
Conflict of Interest None.
References
1. Evans AK, Licameli G, Brietzke S, Whittemore K, Kenna M.
Pediatric facial nerve paralysis: patients, management and out-
comes. Int J Pediatr Otorhinolaryngol. 2005;69:1521–8.
2. McDonald D, Buttery J, Pike M. Neurological complications of
Kawasaki disease. Arch Dis Child. 1998;79:200.
3. Wright H, Waddington C, Geddes J, Newburger JW, Burgner D.
Facial nerve palsy complicating Kawasaki disease. Pediatrics.
2008;122:e783–785.
4. Kobayashi T, Fuse S, Sakamoto N, et al. A new Z score curve of the coro-
nary arterial internal diameter using the lambda-mu-sigma method in
a pediatric population. J Am Soc Echocardiogr. 2016;29:794–801.e29.
Publisher’s Note Springer Nature remains neutral with regard to
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* Hiroshi Masuda
masuda-h@ncchd.go.jp
1
Center for Postgraduate Education and Training, National
Center for Child Health and Development (NCCHD), Tokyo,
Japan
2
Department of General Pediatrics and Interdisciplinary
Medicine, National Center for Child Health and Development
(NCCHD), Tokyo, Japan
3
Division of Palliative Medicine, National Center for Child
Health and Development (NCCHD), Tokyo, Japan
4
Division of Otorhinolaryngology, National Center for Child
Health and Development (NCCHD), Tokyo, Japan

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