Peripheral facial nerve palsy in a child with reactivated Epstein-Barr virus infection and human herpesvirus 6 infection: a case report

Abstract

Neurological complications of Epstein-Barr virus (EBV) infection include a wide range of diseases with the involvement of both central and peripheral nervous systems. Peripheral facial nerve palsy is the most common cranial nerve damage and herpesviruses play an important role in its etiology. We present a clinical case of peripheral facial nerve palsy associated with reactivation of EBV infection and human herpesvirus type 6 (HHV-6) infection in a 16-year-old boy.

The aim of the study is to describe a clinical case of peripheral facial nerve palsy in a child with associated herpesvirus infection.

Clinical case. A 16-year-old boy was hospitalized in the neurology department with complaints of numbness of the tongue, lips, enlargement of the submandibular lymph nodes and parotid salivary glands, facial asymmetry, dry eyes, and mild redness of the sclera. The submandibular lymph nodes were enlarged to 2.5 cm in diameter, tender to palpation, mobile, and not adherent to the surrounding tissues. The parotid and sublingual salivary glands are enlarged, dense, and painful on palpation. Pathological neurological symptoms were detected: sagging eyebrows, lagophthalmos on the left side, nasolabial folds S˂D, and drooping of the left corner of the mouth. It was performed: DNA HHV-6 - 1.03×10⁴ copies and DNA EBV - 7.65×10⁵ copies were detected. Immune enzyme analysis of serum revealed positive anti-VCA IgG, anti-EA IgG, and anti-EBNA IgG. Antiviral treatment was prescribed - valganciclovir and recombinant human interferon alpha-2b. On the background of antiviral therapy from week 3, a noticeable regression of neurological symptoms was observed, and by week 5, the size of the salivary glands had normalized.

Conclusions. In the case of neuropathy, EBV and its association with other herpesviruses, particularly HHV-6, should be considered as a possible etiologic factor. Tests to detect these pathogens should be included in the list of workups for such patients. In addition to the characteristic lymphadenopathy, sialoadenitis is one of the important clinical markers of replicative forms of infections caused by EBV and HHV-6.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The informed consent was obtained from the patient and parents.

The authors declare no conflict of interest.