engleski

A CASE REPORT OF FACIAL NERVE PALSY ASSOCIATED WITH VARICELLA INFECTION

Introduction/Objectives: Neurological complications caused by varicella are estimated to occur in approximately 0.01-0.03% of infections. Frequent complications are cerebellar ataxia and encephalitis while the rare complications are facial paralysis, transverse myelitis, aseptic meningitis, Guillain-Barre syndrome, ventriculitis, optic neuritis, peripheral motor neuropathy, cerebral angiitis and Reye´s syndrome. Facial palsy can be a result of preeruptive hematogenous or neurogenous spread of varicella zoster virus. Objectives: Review the case of acute peripheral facial palsy as a rare complication of varicella. Case report: A 3-year-old girl presented with a 5-day history of fever and widespread vesicular/pustular rash typical for varicella with clinical signs of secondary bacterial infection of skin, and we clinically confirmed diagnosis of impetigo as a varicella complications. The fifth day after the rash appears she developed inability to close left eye and facial asymmetry with the lower left corner of the lips. There was no clinical history of retroauricular pain, hyperacusis, decreased production of tears and altered taste. Complete neurological examination revealed left peripheral facial nerve palsy without any abnormal features. The diagnosis facial nerve palsy associated with varicella was based on clinical, laboratory and neurophysiological findings. Aside from local therapy and antibiotic clindamicin for 7 days, patient was treated with acyclovir 10mg/kg IV q8h for 7 days and oral prednisolone (1 mg/kg q24h ) in tapering doses for 2 weeks. In the third week follow-up complete recovery of neurological deficit was noted. Hematological– biochemical tests registered a mild increase inflammatory markers and neutrophilia, until liver and kidney enzyme analysis were within reference range. Lumbar puncture obtained first day of admission and CSF analysis showed mononuclear pleocytosis (108 white cell/mm3 , 86, 4 % lymphocytes), glucose and protein level was in normal range. CSF cultures for bacteria, fungus and tuberculosis were negative. Serological test for B. burgdorferi was nonreactive. The patient had a bilateral type A tympanogram, stapedial reflex was absent in the left ear. Ocular fundus (FOU) was normal. Conclusions: We suggest that, aside from a frequent central nervous complications, children with varicella should be monitored closely for facial nerve palsy as well. The prognosis of facial palsy due to varicella is generally good and 80% cases recover with or without treatment, but specific acyclovir and prednisolone therapy may accelerate the complete recovery like in our case. Keywords: facial nerve palsy, varicella.

facial nerve palsy ; varicella infection

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