Ptosis as a complication of Kawasaki disease

Abstract

Kawasaki disease is an acute febrile exanthematous disease that affects children younger than 5 years of age. It is regarded as the most common cause of childhood acquired heart disease, but ocular and neurological problems are among the other important clinical findings. We present a 3-year-old boy who developed bilateral ptosis on day 21, 5 days after intravenous immunoglobulin. The ptosis was due to bilateral paralysis of the levator palpebrae superioris muscles and resolved spontaneously on day 25. There were no cardiac sequelae.

Refusal to Walk and Ptosis as an Atypical Presentation of Kawasaki Disease

“…Involvement of arteries supplying the levator eyelid muscles, myositis or immune-mediated nerve involvement, have been proposed as mechanisms. 4 What had not been described so far is a myastheniform condition secondary to the existence of ACRA, as we found out in our patient.…”

“…Neurological symptoms may appear throughout the course of KD, ptosis is very rare, as only 5 cases have been published previously. [2][3][4][5] It seems to be a late complication that appears between the second and fourth week from the onset of symptoms. In none of the cases, ptosis was remitted after immunoglobulins administration.…”

Association Between Kawasaki Disease and Childhood Epilepsy: A Nationwide Cohort Study in Taiwan

“…Since then, numerous neurological involvements associated with KWD have been discovered ( 9 ). These include headache, convulsions, somnolence, irritability, meningoencephalit5is, ptosis, sensorineural hearing loss, and facial palsy ( 4 , 6 , 7 ). Even so, most of them subsided completely following the successful management of KWD without any clinically apparent signs of CNS injury.…”

“…Even so, most of them subsided completely following the successful management of KWD without any clinically apparent signs of CNS injury. However, few studies have examined whether acute KWD is followed by subtle but clinically apparent changes in the brain of children, which might lead to the long-term development of NDDs ( 4 – 7 ). Therefore, the present study adopted a larger nationwide database to trace the incidence of epilepsy in Taiwanese children with KWD.…”

“…Despite neurological complications involving the central nervous system (CNS) not being uncommon in KWD, the extent of their influence on the brains of children and the effect of KWD on the development of various neurodevelopmental disorders (NDD) remains unclear ( 3 ). Although neurological complications such as seizures, hemiplegia, facial palsy, cerebral vasculitis, myositis, and aseptic meningitis have been occasionally reported in conjunction with KWD, the long-term sequelae such as epilepsy have never been reported ( 4 – 7 ).…”