Abstract
BackgroundRecurrent benign 6th nerve palsy in the paediatric age group is uncommon, but has been described following viral and bacterial infections. It has also been temporally associated with immunization, but has not been previously described following two different live attenuated vaccines.Case presentationA case is presented of a 12 month old Caucasian boy with recurrent benign 6th nerve palsy following measles-mumps-rubella and varicella vaccines, given on separate occasions with complete recovery following each episode. No alternate underlying etiology was identified despite extensive investigations and review.ConclusionsThe majority of benign 6th nerve palsies do not have a sinister cause and have an excellent prognosis, with recovery expected in most cases. The exact pathophysiology is unknown, although hypotheses including autoimmune mechanisms and direct viral invasion could explain the pathophysiology behind immunization related nerve palsies. It is important to rule out other aetiologies with thorough history, physical examination and investigations. There is limited information in the literature regarding the safety of a repeat dose of a live vaccine in this setting. Future immunizations should be considered on a case-by-case basis.
Highlights
Recurrent benign 6th nerve palsy in the paediatric age group is uncommon, but has been described following viral and bacterial infections
Recurrence has been temporally associated with immunization [4], including both inactivated and live attenuated viral vaccines (Table 1)
Whilst an isolated 6th cranial nerve palsy may seem less likely to be due to an underlying sinister cause, up to a third of such palsies in children have a neoplastic origin [14]
Summary
Prognosis for benign recurrent 6th nerve palsy is excellent. Benign 6th nerve palsy post-immunization is a rare occurrence that generally resolves spontaneously but needs to be thoroughly investigated and followed-up to ensure best outcome. Consent Written informed consent was obtained from the patient’s parents for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Series Editor of this journal. NWC and JPB have acted as chief investigators for epidemiological studies sponsored by vaccine manufacturers (CSL) and serological testing (Merck). All payments, including for sitting on advisory boards (NWC), data safety monitoring boards (JPB), lecturing (NWC) and travel expenses for attendance at scientific meetings, are paid directly to an administrative fund held by Murdoch Children’s Research Institute
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