Kawasaki Disease Associated with Streptococcal Infection and Facial Nerve Palsy: A Case Report
Background: Kawasaki disease (mucocutaneous lymph node syndrome), an acute febrile vasculitis of childhood that affects medium and small-sized arteries, is uncommonly reported in the West African subregion. Its diagnosis relies on the presence of a constellation of clinical signs which could mimic o...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Ntec Specialist
2022-01-01
|
| Series: | Kanem Journal of Medical Sciences |
| Subjects: | |
| Online Access: | https://www.ajol.info/index.php/kjms/article/view/236576/223535 |
| _version_ | 1828264453798363136 |
|---|---|
| author | Abdullahi Musa Abiola A. Olorukooba Sakinatu M. Abdullahi Sani Musa Hauwa U. Makarfi |
| author_facet | Abdullahi Musa Abiola A. Olorukooba Sakinatu M. Abdullahi Sani Musa Hauwa U. Makarfi |
| author_sort | Abdullahi Musa |
| collection | DOAJ |
| description | Background: Kawasaki disease (mucocutaneous lymph node syndrome), an acute febrile vasculitis of childhood that affects medium and small-sized arteries, is uncommonly reported in the West African subregion. Its diagnosis relies on the presence of a constellation of clinical signs which could mimic or coexist with infectious viral or bacterial agents, thereby requiring a high index of suspicion. Case presentation: We report a two-year, ten months-old boy who presented with prolonged high-grade fever for over 3 three weeks; non-purulent conjunctivitis, unilateral cervical lymphadenopathy, cracked lips, reddish tongue, diffuse oedema, erythema of his palms and soles; skin desquamation over the tips of his digits and left-sided facial nerve palsy. He had leukocytosis, thrombocytopenia, and elevated inflammatory markers. Throat swab yielded Streptococcus pyogenes species; however, serial echocardiography was unrevealing. He was managed with aspirin, steroids, bed rest, and antibiotics (based on culture sensitivity), but intravenous immunoglobulin (IVIG) was not readily available and therefore was not administered. His inpatient clinical course showed fever persisting into the second week of inpatient management that gradually became undulating by the third week before lysing. Conclusion: The rare complication of facial nerve palsy is highlighted, while the evidence for acute bacterial infection posed further diagnostic challenges in this child with clinical features of Kawasaki disease. The unavailability of IVIG also portends a prolonged course for the acute stages, which are largely unresponsive to antipyretics and antibiotics. The importance of longterm follow-up for potential coronary artery aneurysms in the face of risk factors is further emphasized. |
| first_indexed | 2024-04-13T04:24:42Z |
| format | Article |
| id | doaj.art-2ab07e1c8880481d87aa84bfd4c9a0a8 |
| institution | Directory Open Access Journal |
| issn | 2006-4772 2714-2426 |
| language | English |
| last_indexed | 2024-04-13T04:24:42Z |
| publishDate | 2022-01-01 |
| publisher | Ntec Specialist |
| record_format | Article |
| series | Kanem Journal of Medical Sciences |
| spelling | doaj.art-2ab07e1c8880481d87aa84bfd4c9a0a82022-12-22T03:02:33ZengNtec SpecialistKanem Journal of Medical Sciences2006-47722714-24262022-01-011527780doi.org/10.36020/kjms.2022.1601.01020221Kawasaki Disease Associated with Streptococcal Infection and Facial Nerve Palsy: A Case ReportAbdullahi Musa0Abiola A. Olorukooba1Sakinatu M. Abdullahi2Sani Musa3Hauwa U. Makarfi4Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika – ZariaDepartment of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika – ZariaDepartment of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika – ZariaDepartment of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika – ZariaDepartment of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika – ZariaBackground: Kawasaki disease (mucocutaneous lymph node syndrome), an acute febrile vasculitis of childhood that affects medium and small-sized arteries, is uncommonly reported in the West African subregion. Its diagnosis relies on the presence of a constellation of clinical signs which could mimic or coexist with infectious viral or bacterial agents, thereby requiring a high index of suspicion. Case presentation: We report a two-year, ten months-old boy who presented with prolonged high-grade fever for over 3 three weeks; non-purulent conjunctivitis, unilateral cervical lymphadenopathy, cracked lips, reddish tongue, diffuse oedema, erythema of his palms and soles; skin desquamation over the tips of his digits and left-sided facial nerve palsy. He had leukocytosis, thrombocytopenia, and elevated inflammatory markers. Throat swab yielded Streptococcus pyogenes species; however, serial echocardiography was unrevealing. He was managed with aspirin, steroids, bed rest, and antibiotics (based on culture sensitivity), but intravenous immunoglobulin (IVIG) was not readily available and therefore was not administered. His inpatient clinical course showed fever persisting into the second week of inpatient management that gradually became undulating by the third week before lysing. Conclusion: The rare complication of facial nerve palsy is highlighted, while the evidence for acute bacterial infection posed further diagnostic challenges in this child with clinical features of Kawasaki disease. The unavailability of IVIG also portends a prolonged course for the acute stages, which are largely unresponsive to antipyretics and antibiotics. The importance of longterm follow-up for potential coronary artery aneurysms in the face of risk factors is further emphasized.https://www.ajol.info/index.php/kjms/article/view/236576/223535kawasaki diseasestreptococcal infectionfacial nerve palsy |
| spellingShingle | Abdullahi Musa Abiola A. Olorukooba Sakinatu M. Abdullahi Sani Musa Hauwa U. Makarfi Kawasaki Disease Associated with Streptococcal Infection and Facial Nerve Palsy: A Case Report Kanem Journal of Medical Sciences kawasaki disease streptococcal infection facial nerve palsy |
| title | Kawasaki Disease Associated with Streptococcal Infection and Facial Nerve Palsy: A Case Report |
| title_full | Kawasaki Disease Associated with Streptococcal Infection and Facial Nerve Palsy: A Case Report |
| title_fullStr | Kawasaki Disease Associated with Streptococcal Infection and Facial Nerve Palsy: A Case Report |
| title_full_unstemmed | Kawasaki Disease Associated with Streptococcal Infection and Facial Nerve Palsy: A Case Report |
| title_short | Kawasaki Disease Associated with Streptococcal Infection and Facial Nerve Palsy: A Case Report |
| title_sort | kawasaki disease associated with streptococcal infection and facial nerve palsy a case report |
| topic | kawasaki disease streptococcal infection facial nerve palsy |
| url | https://www.ajol.info/index.php/kjms/article/view/236576/223535 |
| work_keys_str_mv | AT abdullahimusa kawasakidiseaseassociatedwithstreptococcalinfectionandfacialnervepalsyacasereport AT abiolaaolorukooba kawasakidiseaseassociatedwithstreptococcalinfectionandfacialnervepalsyacasereport AT sakinatumabdullahi kawasakidiseaseassociatedwithstreptococcalinfectionandfacialnervepalsyacasereport AT sanimusa kawasakidiseaseassociatedwithstreptococcalinfectionandfacialnervepalsyacasereport AT hauwaumakarfi kawasakidiseaseassociatedwithstreptococcalinfectionandfacialnervepalsyacasereport |