Case Report of Unusual Facial Swelling in an 8-Month-Old

Rhabdomyolysis is a potentially life-threatening disease defined by the release of intracellular contents into the body’s circulation after muscle damage. It is most commonly seen in adult patients who present with crush injuries, overexertion, or prolonged immobility due to drug and/or alcohol overdose. Fortunately, it is rare in young children. We present the case of an 8-month-old girl with progressively worsening right-sided facial swelling that was associated with significant drooling and intraoral edema. The patient had been found lying prone and wedged between a mattress and the adjacent bedroom wall. After laboratory and imaging work-up, this child’s injury was the result of prolonged facial muscle compression with resultant rhabdomyolysis. The patient improved during hospital admission with intravenous (IV) fluids, two days of steroids for facial swelling, and five days of antibiotics to treat superficial cellulitis. At 2-week follow-up, her swelling resolved with minimal residual facial scarring and a mild right facial nerve palsy. This patient’s unusual history and clinical presentation challenges providers to explore rhabdomyolysis as a differential diagnosis in young children who present with localized severe swelling. TOPICS: Facial edema, rhabdomyolysis, facial cellulitis, non-accidental trauma.