Post-inflammatory Isolated Bilateral Palatal Palsy Following Enteric Fever: A Report of a Rare Pediatric Case

Isolated acquired palatal palsy is an uncommon neurological condition in children and adolescents caused by selective dysfunction of the pharyngeal branch of the vagus nerve. Patients typically present with nasal regurgitation of liquids and feeds, hypernasal speech (nasal twang), and dysphagia due to impaired palatal movement. The condition is often considered post-infectious and has been associated with several viral and bacterial infections. We report a rare case of isolated bilateral palatal paralysis following an enteric fever in a 17-year-old girl. She presented with the sudden onset of painless nasal regurgitation of liquids and feeds, accompanied by a nasal quality of speech. A comprehensive clinical evaluation was undertaken to exclude structural, infectious, and neuromuscular causes of palatal dysfunction. Magnetic resonance imaging of the brain revealed no abnormalities. Isolated palatal palsy is an uncommon neurological disorder, and several viral and bacterial infections, including diphtheria, influenza, varicella, and enteric fever, have been implicated as potential precipitating factors. In the present case, the temporal association with enteric fever and the exclusion of other etiologies suggest a post-infectious immune-mediated neuropathy as the likely mechanism. Based on the clinical presentation and the exclusion of structural, infectious, and neuromuscular causes, a diagnosis of post-infectious isolated bilateral palatal palsy was established. The child was commenced on oral methylprednisolone therapy. Significant clinical improvement was observed within three days of treatment initiation, with progressive resolution of symptoms thereafter. Complete recovery was achieved within 10 days, marked by the cessation of nasal regurgitation and restoration of normal speech. The rapid and favorable response to corticosteroid therapy further supported the presumed inflammatory or immune-mediated etiology of the condition. Palatal palsy is a recognized neurological complication of enteric fever; however, most reported cases in the literature describe unilateral involvement. Bilateral palatal palsy is exceptionally rare, with only a few cases documented to date. The rarity of bilateral involvement makes the present case a unique clinical observation. Despite its rarity, early recognition is essential to avoid unnecessary investigations and to ensure timely treatment and recovery.