Unilateral Peripheral Facial Palsy Associated with Epstein - Barr virus Infection in a Child

Abstract

In pediatric patients, facial nerve palsy (FNP) is uncommon. The most common causes are infections. A 3 year-8 month-old boy presented to our hospital with left FNP and severe lymphadenopathy. When seen for the first time at our hospital, the patient had fever and left FNP, bilateral mandibular lymphadenopathy, left parotid gland enlargement, purulent tonsillopharyngeal exudate, acute otitis media, and splenomegaly. EBV PCR showed 1298 copy/mL. Acyclovir addition to steroid was initiated. Despite all these therapies a marked recovery at FNP was not observed so myringotomy was done and a ventilation tube was inserted. Further intratympanic steroid injection was done. A complete recovery is established in our patient at the 8th week of treatment. Although it is well known that FNP is generally a disease with good prognosis, in the ones due to infectious causes such as EBV, the recovery period may be prolonged despite appropriate medical and surgical treatment.

Keywords

• Infectious mononucleosis; peripheral facial paralysis; treatment

References

1. Terada K, Niizuma T, Kosaka Y, et al. Bilateral facial nerve palsy associated with Epstein-Barr virus infection with a review of the literature. Scand J Infect Dis 2004;36:75-7.
2. Oncel C. A rare clinical presentation of Ebstein-Barr virus. Braz J Infect Dis 2010;14:211-2.
3. Rowlands S, Hooper R, Hughes R, and Burney P. The epidemiology and treatment of Bell’s palsy in the UK. Eur J Neurol 2002; 9: 63-7.
4. Evans AK, Licameli G, Brietzke S, Whittemore K, Kenna M. Pediatric facial nerve paralysis: patients, management and outcomes. Int J Pediatr Otorhinolaryngol 2005;69:1521-8. 5- Grundfast KM, Guarisco JL, Thomsen JR, Koch B. Diverse etiologies of facial paralysis in children. Int J Pediatr Otorhinolaryngol 1990;19:223-39.
5. Chen WX, Wong V. Prognosis of Bell’s palsy in children-analysis of 29 cases. Brain Dev 2005;27:504-8.
6. Rafailidis PI, Mavros MN, Kapaskelis A, Falagas ME. Antiviral treatment for severe EBV infections in apparently immunocompetent patients. J Clin Virol 2010;49:151-7. 8- Gaio E, Marioni G, de Filippis C, et al. Facial nerve paralysis secondary to acute otitis media in infants and children. J Paediatr Child Health 2004;40:483-6.
7. Lorch M, Teach SJ. Facial nerve palsy: Etiology and approach to diagnosis and treatment margarita. Pediatr Emer Care 2010; 26: 763-72.