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Eyelid ptosis and muscle weakness in a child with Kawasaki disease: a case report
Yao Lin1, Lijun Wang1, Aijie Li1
1Department of Pediatric Cardiology, Children's Hospital, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, China.
Insights
Kawasaki disease (KD) can cause rare neurological symptoms like ptosis and muscle weakness in children. Prompt treatment with IVIG, aspirin, and corticosteroids can effectively resolve these KD-related neuromuscular complications.
Area of Science:
- Pediatric Rheumatology
- Neurology
- Vascular Biology
Background:
- Kawasaki disease (KD) is a critical pediatric illness characterized by acute febrile vasculitis, primarily affecting children under five.
- Neuromuscular complications, such as ptosis and muscle weakness, are infrequently documented in KD cases.
Observation:
- A 3-year-old boy diagnosed with KD presented with significant ptosis and muscle weakness (grade IV upper limb, grade III lower limb).
- Initial investigations revealed hypokalemia (2.62 mmol/L), which normalized with potassium supplementation.
- Despite correction of hypokalemia, ptosis and muscle weakness persisted, necessitating further neurological workup including MRI and EMG, which ruled out primary neural or muscular disorders.
Findings:
- The patient received standard KD treatment: intravenous immunoglobulin (IVIG), aspirin, and adjunctive methylprednisolone.
- Neuromuscular symptoms showed a delayed but complete resolution: ptosis resolved by day 6, and muscle strength, tone, and ambulation normalized by day 14.
- This suggests a potential direct or indirect impact of KD on neuromuscular function, responsive to anti-inflammatory therapy.
Implications:
- Kawasaki disease may manifest with neurological and muscular system involvement, including ptosis and weakness.
- The successful treatment outcome highlights the efficacy of standard anti-inflammatory protocols, including corticosteroids, for managing these rare KD complications.
- Increased awareness and diagnostic vigilance for neuromuscular involvement in pediatric KD cases are warranted.
Background:
Kawasaki disease (KD) is an acute febrile vasculitis that often occurs in children under 5 years. Ptosis and muscle weakness associated with KD are rarely documented.
Case Presentation:
We present a case of KD with eyelid ptosis and muscle weakness in a 3-year-old boy. At admission, grade IV and grade III muscle strength were recorded for upper and lower limbs, respectively. Diminished patellar tendon reflex was noted. Laboratory evaluation showed hypokalemia with the serum potassium concentration of 2.62 mmol/L. Intravenous immunoglobulin (IVIG) and aspirin were initiated immediately accompanied with methylprednisolone for adjunctive therapy. Potassium supplement was administered at the same time, which resulted in the correction of hypokalemia on the 2nd day of admission but no improvement in ptosis and muscle weakness. Neostigmine testing, lumber puncture, electromyography, and cerebral and full spine MRI were performed, which, however, did not find evidence for neural and muscle diseases. On the 5th day, the fever was resolved. On the 6th day, eyelid ptosis disappeared. And on the 14th day, the muscle strength and muscle tension returned to normal, patellar tendon reflex could be drawn out normally, and the boy regained full ambulatory ability.
Conclusions:
KD might affect the neural and muscular systems, and KD complicated with eyelid ptosis and muscle weakness is responsive to the standard anti-inflammatory treatment plus adjunctive corticosteroid therapy.
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