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Article in Japanese

Bilateral facial nerve palsy associated with Guillain-Barré syndrome by antecedent mumps virus infection: A case report

Haruki KAMAGAI1), Yasuhiro IKAWA1), Yusuke MATSUDA1), Tetsujiro SHIRAHASHI1), Akiko KATO1), Mondo KURODA1), Akihiro YACHIE1)

The cardinal symptom of mumps virus infection is acute parotitis; however, unilateral facial nerve palsy may develop as a minor complication. This study reported a 12-year-old female Guillain-Barré syndrome (GBS) patient, who developed bilateral facial nerve palsy by antecedent mumps virus infection. She presented with paresthesia of the extremities and lower extremity muscle weakness 10 days before admission, and had mumps virus infection from 1 month previously. She was admitted to this hospital because of her drooling and difficulty in closing both eyes. Nerve conduction studies of her extremities revealed delayed latency of motor and sensory nerves, and cerebrospinal fluid testing showed albuminocytological dissociation. In accordance with these findings, her illness was diagnosed as GBS with bilateral facial nerve palsy by antecedent mumps virus infection. Intravenous immunoglobulin therapy (IVIg) was started and her clinical symptoms disappeared immediately. Longitudinal T-cell receptor variable beta chain repertoire analysis showed skewed distribution of CD57+Vb13.2+CD8+ lymphocytes from hospital admission to clinical remission. In general, first-line therapy for facial nerve palsy includes steroid therapy. However, the treatment strategy for GBS is not steroid therapy, due to resistance, and IVIg was performed instead. Therefore, clinicians must consider the causative disorder of bilateral facial nerve palsy after mumps virus infection. If palsy is caused by GBS, then early medical intervention by IVIg is warranted. Moreover, elucidation of the mechanisms of skewed distribution of T lymphocytes may shed light on the pathophysiology of GBS.

1) Department of Pediatrics, Kanazawa University Hospital

Key words
Received March 8, 2017
Accepted August 2, 2017

29 (3):263─271,2017