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July 1997

Picture of the Month

Author Affiliations

From Starship Children's Health (Dr Wilson) and the Department of Paediatrics (Dr Grant), School of Medicine, University of Auckland, Auckland, New Zealand.

Arch Pediatr Adolesc Med. 1997;151(7):739-740. doi:10.1001/archpedi.1997.02170440101018

A boy presented with a 1-day history of right facial palsy (Figure). Physical examination results revealed marked cervical lymphadenopathy, large erythema tous tonsils with an exudate, and bilateral otitis media.

Middle ear fluid obtained by tympanocentesis and a blood sample were sterile on culture. A throat swab yielded normal oral flora.

Denouement and Discussion 

Facial Nerve Palsy Secondary to Epstein-Barr Virus Infection  Epstein-Barrfections are common in children. Epstein-Barr virus seroconversion occurs before the age of 5 years in approximately 50% of the population.1 Common clinical features of EBV infections include fever, lymphadenopathy, exudative tonsillopharyngitis, and splenomegaly.2 Although most children do not experience significant complications associated with this infection, occasional children may develop serious morbidity associated with splenic rupture and arrhthymias secondary to myocarditis.3Neurologic complications are relatively uncommon in children with EBV infections, occurring in approximately 8% of those infected.4 Meningoencephalitis is the most common central