Abducens nerve palsy: a rare copresenting sign of incomplete Kawasaki Disease

Abstract

A 21-month-old girl presented with acute-onset esotropia with unexplained fever, conjunctivitis, and rash. Sensorimotor examination revealed the presence of a left abducens nerve palsy. After cardiogenic shock, she was found to have multiple large coronary artery aneurysms and was diagnosed with incomplete Kawasaki disease. The patient eventually had near-resolution of her abducens nerve palsy with treatment for her underlying Kawasaki disease through aspirin, infliximab, and intravenous immunoglobulin therapy. Abducens nerve palsy is a rare manifestation of Kawasaki disease that may reflect a late diagnosis and an increased risk of coronary artery involvement.