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Drs Sinha and Balakumar remind us in their article that BCG scar
reactivation is a diagnostic marker for Kawasaki's Disease (1). Drs Gandhi
and Wilson then remind us of the importance of considering incomplete
Kawasaki's Disease in the context of many clinical scenarios (2). They
provide a comprehensive list of several neurological manifestations and
complications of Kawasaki's Disease.
We would like to add to this list by describing a 10 year old girl
with Kawasaki's Disease who developed bilateral Lateral Rectus (LR) palsy
and papillodema 15 days after treatment with IV immunoglobulin. Cranial
Computerised Tomography showed no space occupying lesion. CSF pressure was
27, and suggested a picture of aseptic meningitis (45 white cells, Protein
0.16). Her lateral rectus palsy and papilloedema resolved after 46 days,
We postulate the opthalmoplegia to be multifactorial. Firstly there
seems to be some intracranial hypertension, suggested by the raised CSF
pressure. This could be Benign Intracranial Hypertension (a rare
complication of IV immunoglobulin), or related to aseptic meningitis. We
also wonder, however, whether the Lateral rectus palsy was also directly
related to the Kawasaki's Disease. Facial nerve palsy is well described in
the literature, and is thought to be due to nerve ischaemia secondary to
vaculitis. There is one other reported case of LR palsy associated with
Kawasaki's Disease (3).
It is important that clinicians are aware of atypical presentations
and unusual complications of Kawasaki's Disease. Neurological
complications should be actively sought during the clinical assessment of
potential patients with the condition. Conversely, Kawasakis Disease
should be considered in the differential diagnosis of some neurological
1)Sinha R,Balakumar T. BCG reactivation: a useful diagnostic tool even
for incomplete Kawasaki disease. Arch. Dis. Child., Sep 2005; 90: 891.
2)Gandhi A,Wilson DG.Incomplete Kawasaki disease: not to be forgotten.
Arch. Dis. Child., Mar 2006; 91: 276 - 277
3)Wurzburger, Brenda J. M.D.; Avner, Jeffrey R. M.D.
Lateral rectus Palsy in Kawasaki's Disease.Pediatric Infectious Disease
Journal. 18(11):1029-1031, November 1999.