Kawasaki disease complicating bilateral facial nerve palsy and giant coronary artery aneurysms: A case report

RATIONALE: Kawasaki disease (KD), which is also known as mucocutaneous lymphnode syndrome, is a vasculitic disease and involves multi-system disorder with various clinical manifestations. KD is specific predilection for the coronary arteries and is the most common cause of childhood-acquired heart disease in developed countries. KD is rarely complicated by cranial nerve VII palsy. PATIENT CONCERNS: This report described a 7-month-old infant who suffered from bilateral infranuclear facial nerve palsy (FNP) and multiple coronary artery aneurysms (CAAs) in parallel with KD. The patient had an intermittent fever for 18 days and had a medical history of bilateral conjunctival injection, strawberry tongue, reddened lips, and perianal excoriation. Physical examinations revealed fever (38.5°C), fingertips desquamation of the skin, and left cervical lymphadenopathies. DIAGNOSIS: The diagnosis of KD is based on the presence of clinical features of persistent fever (≥5 days) together with polymorphous exanthema, cervical lymphadenopathy, non-purulent conjunctival injection, changes of the lips, oral cavity, and extremities. An echocardiogram has showed a beaded sample dilatation of all coronary arteries, in addition to aneurysms of the middle of the right coronary artery (6.2 mm in diameter; 14.5 Z score), and the left coronary artery (5.4 mm in diameter; 9.4 Z score). The physical examinations revealed incomplete closure of both eyes and bilateral drooping of the mouth, suggesting a bilateral infranuclear FNP. INTERVENTIONS: The patient received intravenous immunoglobulin (IVIG) (2 g/kg) with high-dose aspirin according to the clinical guidelines. OUTCOMES: Her fever finally resolved after 2 days’ IVIG. All inflammatory indexes returned to normal or near-normal levels prior to discharge. However, the echocardiogram remained unchanged and the patient's facial nerve palsies had not recovered. LESSONS: FNP in KD is uncommon. Yet, it may be a marker of disease progression. One should be aware of the diagnosis of KD when children suffer from high fever, FNP, and even with incomplete clinical features.