Abducens nerve palsy in a child with Kawasaki disease: a case report

We describe herein the case of a 9-year-old girl with incomplete Kawasaki disease (KD) and concurrent Mycoplasma pneumoniae infection who developed progressive abducens nerve palsy after receiving two doses of intravenous immunoglobulin for intravenous immunoglobulin-resistant disease.Initial presentation included fever, conjunctival injection, rash, coronary artery dilation, and pneumonia.On hospital day 4, our patient developed esotropia and diplopia of the left eye, with these conditions later involving the right eye.These symptoms were accompanied by papilledema, headache, and dizziness.Analysis of the cerebrospinal fluidshowed mild pleocytosis, elevated protein levels, and rapid flow suggestive of increased intracranial pressure;the neuroimaging findings were unremarkable.Treatment with corticosteroids and osmotic agents led to complete resolution of the symptoms.A literature review revealed that abducens nerve palsyin KD varies in onset, laterality, and its association with intracranial hypertension.Proposed mechanisms include vasculitis, immune-mediated neuropathy, and aseptic meningitis.This case emphasizes the importance of prompt neurological evaluation in patients with KD who present with ocular symptoms, particularly in the context of intravenous immunoglobulin-resistant disease.