Isolated unilateral palatal palsy secondary to COVID-19 infection in a child

Abstract

Background: Unilateral acquired isolated palatal paralysis is a very rare entity seen in children. It usually occurs due to isolated involvement of the pharyngeal branch of the vagus nerve. The definite etiopathogenesis is still unclear, but postinfectious immune-associated cranial mono-neuropathy is frequently postulated as plausible cause. We report an Indian girl who presented with isolated right palatal palsy following a coronavirus disease 2019infection. To the best of our knowledge, this has never been described in the literature before. Clinical Description: A 7.5-year-old girl child presented with nasal twang of voice and nasal regurgitation of liquids mainly from the right side of her mouth for 7 days. There was no evidence of any other neurological or systemic involvement. There was no history suggestive of any of the common causes usually attributed to palataopharyngeal palsy. Examination revealed right palatal palsy with deviation of the uvula to the left confirming lower motor neuron weakness of the pharyngeal branch of the vagus nerve. Management: Routine investigations excluding usual etiological causes were normal. The severe acute respiratory syndrome–corona virus 2 (SARS-CoV-2) immunoglobulin G antibody test was positive. The final diagnosis was postinfectious immune-mediated demyelinating isolated right palatal palsy. The child responded dramatically to a short pulse of methylprednisolone for 3 days 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 palatal palsy.