New Leukemia Presenting as Facial Palsy In Children

Written by Clay Smith

Spoon Feed
Facial nerve palsy in children may very rarely be caused by leukemia. If starting steroids, consider a CBC first.

Why does this matter?
Most of the time, facial nerve palsy in children is idiopathic. But there are other reasons for it, such as a complication of otitis media, Lyme, herpes zoster, and others. This was something I had not previously seen that I thought I needed to add to my differential diagnosis. So, I thought you might benefit from it as well.

This rings a Bell
In the course of an international trial of steroids for Bell’s palsy, 5 cases of leukemia were identified, four of which were new diagnoses (one a CNS relapse of ALL), for a rate of 0.6% (4/644) of all children who present to the ED for this diagnosis. It is known that tumor may cause facial nerve paralysis. It surprised me to learn this could be a manifestation of a hematologic malignancy. Because of this case series, the authors recommend a CBC in children who present with facial nerve palsy of unknown etiology, especially if you are planning to start steroids. Starting steroids in a child with unrecognized leukemia can make the diagnosis more difficult and can have an impact on the treatment options available in the future.

Source
Risk of Leukemia in Children With Peripheral Facial Palsy. Ann Emerg Med. 2020 Aug 9:S0196-0644(20)30491-1. doi: 10.1016/j.annemergmed.2020.06.029. Online ahead of print.

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