Facial nerve palsy: an unusual feature of Plasmodium falciparum

Abstract

A ten-year old boy who presented with headache, intermittent high grade fever for four days and left sided deviation of the mouth two days later. Examination revealed a fully conscious patient with an axillary temperature of 39.5 0 C and right facial nerve palsy, lower motor neuron lesion. No other obvious abnormality was detected in any of the systems. Laboratory examination showed positive Plasmodium falciparum (P. falciparum) with a density of 28,000 parasites/mm 3 . Cranial computerized tomographic scan and abdominal ultra-sonograghy revealed no abnormality. Cerebrospinal fluid (CSF) analysis showed normal cell count and chemistry. Culture yielded no growth. Retroviral screening test was negative. Complete blood count showed high monocytosis of 18%, other indexes were normal. Electrolytes, urea, creatinine and calcium levels were within normal limits. Urine, stool and blood cultures yielded no growth. Random blood sugar (RBS) and liver function test were normal. Symptoms subsided within 36 hours following administration of intravenous artesunate and oral paracetamol. Complete facial nerve recovery took seven days following clearance of parasitemia. The objective of this report is to draw the attention of clinicians to this uncommon presentation of malaria, though the patho-physiological mechanism remains unclear.