UNILATERAL LATERAL RECTUS PALSY, PAPILLOEDEMA,IN AN ADOLESCENT GIRL WITH MULTISYSTEMIC INFLAMMATORY SYNDROME ASSOCIATED WITH SARS-COV-2 INFECTION.

*Dr. Sasi Anand, Dr. Raeshmi. and Dr. Ramalingam

ABSTRACT

Background: Unilateral acquired isolated lateral rectus paralysis is a very rare entity seen in children. It usually occurs due to trauma, tumour and congenital causes. but postinfectious immune-associated cranial mono-neuropathy is frequently postulated as plausible cause. We report an Indian girl who presented with isolated left lateral rectus palsy following a coronavirus disease 2019infection. Clinical Description: A 11 -year-old girl child presented with fever, cough , swelling and pain over left cervical region and bilateral conjuctival congestion. There was no evidence of any other neurological involvement. There was no history suggestive of any of the common causes usually attributed to lateral rectus palsy. Examination revealed febrile, tachycardia with gallop, left tender cervical adenitis, bilateral conjuctival hemorrhage and later on developed left lateral rectus palsy and papillodema on fundus examination. . Management: Routine investigations suggestive of dengue NS1 antigen positive, covid RT PCR – negative. Secondary HLH investigations were positive. The severe acute respiratory syndrome–corona virus 2 (SARS-CoV-2) immunoglobulin G antibody test was positive. The final diagnosis was postinfectious immune-mediated isolated left lateral rectus palsy. The child responded dramatically to intravenous immunoglobulin and a short pulse of methylprednisolone for 5 days , hypertonic saline infusion and acetazolamide were given and did not display any sequelae on follow-up. Conclusion: In the setting of the current pandemic, we recommend including SARS-CoV-2 serology in the routine workup of children presenting with isolated lateral rectus palsy.

Keywords: COVID-19, SARS-CoV-2, sixth cranial nerve palsy, pediatric, anti-SARS-CoV-2 antibodies.