Maglione Marco, Barlabà Annalisa, Grieco Michela, Cosimi Rosaria, Di Nardo Giangiacomo, Di Marco Giovanni Maria, Gelzo Monica, Castaldo Giuseppe, Tucci Celeste, Iodice Raffaella Margherita, Lonardo Maria Concetta, Tipo Vincenzo, Giannattasio Antonietta
Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, 80129 Naples, Italy.
Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania L. Vanvitelli, 81100 Naples, Italy.
Children (Basel). 2023 Apr 3;10(4):679. doi: 10.3390/children10040679.
The diagnosis of Kawasaki disease (KD) is challenging and often delayed mainly in case of young infants and in presence of an incomplete disease and atypical features. Facial nerve palsy is one of the rare neurologic symptoms of KD, associated with a higher incidence of coronary arteries lesions and may be an indicator of a more severe disease. Here, we describe a case of lower motor neuron facial nerve palsy complicating KD and perform an extensive literature review to better characterize clinical features and treatment of patients with KD-associated facial nerve palsy. The patient was diagnosed at the sixth day of disease and presented extensive coronary artery lesions. A prompt treatment with intravenous immunoglobulins, aspirin and steroids obtained a good clinical and laboratory response, with resolution of facial nerve palsy and improvement of coronary lesions. The incidence of facial nerve palsy is 0.9-1.3%; it is often unilateral, transient, more frequent on the left and seemingly associated with coronary impairment. Our literature review showed coronary artery involvement in the majority of reported cases (27/35, 77%) of KD with facial nerve palsy. Unexplained facial nerve palsy in young children with a prolonged febrile illness should prompt consideration of echocardiography to exclude KD and start the appropriate treatment.
川崎病（KD）的诊断具有挑战性，且常常延迟，主要发生在小婴儿以及疾病不完全且具有非典型特征的情况下。面神经麻痹是KD罕见的神经系统症状之一，与冠状动脉病变的发生率较高相关，可能是疾病更严重的一个指标。在此，我们描述一例KD并发下运动神经元面神经麻痹的病例，并进行广泛的文献综述，以更好地描述KD相关性面神经麻痹患者的临床特征和治疗方法。该患者在疾病第6天被诊断出来，并出现广泛的冠状动脉病变。静脉注射免疫球蛋白、阿司匹林和类固醇的及时治疗取得了良好的临床和实验室反应，面神经麻痹得到缓解，冠状动脉病变有所改善。面神经麻痹的发生率为0.9 - 1.3%；通常为单侧、短暂性，左侧更常见，似乎与冠状动脉损害有关。我们的文献综述显示，在大多数报道的KD伴面神经麻痹病例（27/35，77%）中存在冠状动脉受累情况。对于患有持续性发热疾病的幼儿出现无法解释的面神经麻痹，应考虑进行超声心动图检查以排除KD并开始适当治疗。
