Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2022; 10(33): 12289-12294
Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12289
Multiple cranial nerve palsies with small angle exotropia following COVID-19 mRNA vaccination in an adolescent: A case report
Heejin Lee, Jun Chul Byun, Won Jae Kim, Min Cheol Chang, Saeyoon Kim
Heejin Lee, Department of Pediatrics, Yeungnam University Medical Center, Daegu 42415, South Korea
Jun Chul Byun, Department of Pediatrics, Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea
Won Jae Kim, Department of Ophthalmology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu 42415, South Korea
Min Cheol Chang, Department of Physical Medicine and Rehabilitation, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu 42415, South Korea
Saeyoon Kim, Department of Pediatrics, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu 42415, South Korea
Author contributions: Lee HJ and Byun JC contributed to manuscript writing, editing, and data collection. Kim WJ and Chang MC contributed to data analysis; Kim SY contributed to conceptualization and supervision; and all authors have read and approved the final manuscript.
Supported by 2015 Yeungnam University Research, Korea, No. 215A380222.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Saeyoon Kim, MD, PhD, Associate Professor, Department of Pediatrics, Yeungnam University Medical Center, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, South Korea. sysnow88@hanmail.net
Received: June 30, 2022
Peer-review started: June 30, 2022
First decision: August 1, 2022
Revised: August 8, 2022
Accepted: October 27, 2022
Article in press: October 27, 2022
Published online: November 26, 2022
Processing time: 146 Days and 3 Hours
Abstract
BACKGROUND

Several vaccines against the severe acute respiratory syndrome coronavirus 2 have been approved and widely distributed, raising public concerns regarding the side effects of immunization, as the incidence of ease. Although many adverse events following the coronavirus disease 2019 (COVID-19) vaccine have been reported, neurological complications are relatively uncommon. Herein, we report a rare case of multiple cranial palsies following COVID-19 vaccination in an adolescent patient.

CASE SUMMARY

A previously healthy, 14-year-old Asian girl with facial palsy presented to the emergency department with inability to close the right eye or wrinkle right side of the forehead, and pain in the right cheek. She had received second dose of the COVID-19 mRNA vaccine (Pfizer-BioNTech) 18 days before onset of symptoms. She was diagnosed with Bell’s palsy and prescribed a steroid (1 mg/kg/day methylprednisolone) based on symptoms and magnetic resonance imaging findings. However, the next day, all sense of taste was lost with inability to swallow solid food; the gag reflex was absent. Horizontal diplopia was also present. Due to worsening of her condition, she was given high-dose steroids (1 g/day methylprednisolone) for 3 days and then discharged with oral steroids. Improvement in the symptoms was noted 4 days post steroid treatment completion. At the most recent follow-up, her general condition was good with no symptoms except diplopia; ocular motility disturbances were noted. Hence, prism glasses were prescribed for diplopia relief.

CONCLUSION

Small-angle exotropia was observed in the facial, trigeminal, and glossopharyngeal nerve palsies, in our patient. The etiology of this adverse effect following vaccination was thought to be immunological.

Keywords: SARS-CoV-2; COVID-19; COVID-19 vaccine; Multiple cranial nerve palsies; Facial nerve palsy; Diplopia; Exotropia; Case report

Core Tip: Novel mRNA coronavirus disease 2019 (COVID-19) vaccines have been developed against severe acute respiratory syndrome coronavirus 2. These vaccines are highly effective in preventing COVID-19; however, many side effects have been reported following vaccination. Neurological complications are relatively uncommon but have been reported variously. However, the occurrence of multiple cranial nerve (CN) palsy is rare. Based on our knowledge, this is the first pediatric case of multiple CN palsies following COVID-19 vaccination. Our case demonstrated facial, trigeminal, glossopharyngeal nerve palsies with small-angle exotropia were observed. The etiology of CN palsy following vaccination may be immunological.