Related Experiment Video
Updated: Feb 11, 2026
Facial Nerve Surgery in the Rat Model to Study Axonal Inhibition and Regeneration
Published on: May 5, 2020
Atypical Presentation of Incomplete Kawasaki Disease: A Peripheral Facial Nerve Palsy
Moises Rodriguez-Gonzalez1, Ana Castellano-Martinez2, Alvaro A Perez-Reviriego2
1Pediatric Cardiology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain.
Insights
Facial nerve palsy (FNP) is a rare complication of Kawasaki disease (KD). Delayed diagnosis of incomplete KD in infants, even with atypical symptoms like FNP, increases the risk of serious coronary artery aneurysms (CAAs).
Area of Science:
- Pediatrics
- Neurology
- Cardiology
Background:
- Kawasaki disease (KD) is a multisystem vasculitis with coronary artery aneurysms (CAAs) as a critical complication.
- Peripheral facial nerve palsy (FNP) is an uncommon neurological manifestation of KD, occurring in approximately 0.9% of cases.
Purpose of the Study:
- To report a rare case of FNP in an infant with incomplete KD.
- To emphasize the importance of early KD diagnosis and awareness of atypical presentations to prevent severe complications like CAAs.
Main Methods:
- Case report of a 5-month-old male infant presenting with unilateral FNP during the convalescent phase of incomplete KD.
- Review of diagnostic challenges and treatment delays due to initial misdiagnosis as hand-mouth-foot disease.
Main Results:
- The infant presented with left infranuclear FNP on day 18 of illness, with delayed KD diagnosis beyond the recommended 10-day treatment window.
- The patient developed CAAs, potentially linked to delayed diagnosis, atypical presentation, and increased inflammatory burden.
Conclusions:
- Physicians should consider KD in children with prolonged fever, even with incomplete diagnostic criteria and unusual symptoms like FNP.
- Atypical KD presentations and delayed treatment may heighten the risk of CAAs, possibly necessitating more aggressive management strategies.
Background:
Kawasaki disease (KD) is a multisystem vasculitic disease. Coronary artery aneurysms (CAAs) are the most important and life-threatening complication of KD. Various neurologic complications have been described to occur in 1-30% of patients with KD, but peripheral facial nerve palsy (FNP) is rare (0.9%).
Case Report:
We describe a 5-month-old male infant who presented to us with unilateral left infranuclear FNP in the convalescent phase (day 18 of illness) of incomplete KD. The initial diagnosis was not made during the first 10 days of illness (therapeutic window for immunoglobulin treatment) as he was suspected to have hand-mouth-foot disease. We believe that both the delay in diagnosis and treatment of an atypical presentation of KD, combined with the more severe vasculitis and inflammatory burden reported in these cases, contributed to the development of CAA in our patient. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the importance of considering KD diagnosis in children with prolonged unexplained fever, even with incomplete diagnostic features, as well as the need to be aware of unusual manifestations, such as FNP. Atypical cases like this may be at increased risk of CAA because of delayed diagnosis and a higher inflammatory burden; therefore, a more aggressive treatment approach may be necessary.
Related Concept Videos
01:24Peripheral Nervous System: Ganglia and Nerves
Nerves
The nerve is a bundle of axons that serves as the communication highway in the PNS. Each nerve is ensheathed in a protective layer of connective tissue called the epineurium. This outermost layer safeguards the nerve and supports the...
01:25Self-Presentation
01:30Peripheral Artery Disease I: Introduction
02:05Self-Presentation: Self-Monitoring and Self-Handicapping
01:43Incomplete Dominance
01:12Strategies of Self-Presentation I: Strategic Self-Presentation