Of note, the patient had tested negative for SARS-CoV2 during a prior admission two weeks earlier. can result in longer-term facial muscle weakness or in sequelae such as ocular dryness, lagophthalmos, exposure keratopathy, or swallowing dysfunction . The condition often resolves without treatment, however antiviral and corticosteroid management is typically utilized, especially if diagnosed within 72?h of symptom onset , . A broad array of other etiologies for Bells palsy have been described including traumatic, inflammatory, and infectious processes , , , . In particular, the role of viral infection in association with the condition has been reported with herpetic viral infections observed as a frequent cause , . There are limited reports of an association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and Bells palsy in adults but this seems to Rabbit Polyclonal to PARP (Cleaved-Gly215) be rare with only two cases reports at the time of this report. ,  Bells palsy has never been reported in a child with SARS-CoV-2 seropositivity. Herein, we report the first case of a pediatric patient presenting with acute onset Bells Palsy in the setting of SARS-CoV-2 infection. 2.?Case report A 6-year-old male with history of prematurity (born at 30?weeks gestation), failure to thrive, chromosome 17 and 19 deletions, Entecavir hydrate submucosal cleft palate, surgically repaired atrial and ventricular septal defects, agammaglobulinemia with hyper IgM, hypospadias, asthma, moderate obstructive sleep apnea, and gastrostomy tube feeding presented to the pediatric emergency room with one day history of right sided facial droop. Parents reported an asymmetric smile, drooling, and inability to fully close the right eye. They denied fever or vomiting at home and felt the patient was otherwise behaving at baseline. There was no history of trauma, sick contacts, or recent travel. At baseline, the patient received intravenous immunoglobulin (IVIG) infusion every three weeks for his agammaglobulinemia but was on no other pharmacotherapy. On evaluation, the patient was tachycardic to 116 beats/minute but otherwise afebrile, normotensive and well-appearing. Physical examination and neurologic examination were Entecavir hydrate unremarkable except for a right-sided facial palsy with inability to close the right eye and right sided mouth droop with drooling (House-Brackmann grade: IV). Laboratory testing was significant for an elevated white count at 11.1?K/uL. SARS-CoV-2 Reverse transcription polymerase chain reaction (RT-PCR) nasopharyngeal swab was positive. Herpes Simplex Virus (HSV-1, HSV-2) and Varicella Zoster Virus (VZV) PCR were negative. Of note, the patient had tested negative for SARS-CoV2 during a prior admission two weeks earlier. There were no known contacts or family members with SARS-CoV-2 infections. A respiratory viral panel ten days prior to admission was negative for adenovirus, coronavirus HKU1/229E/NL63E/OC43, metapneumovirus, rhinovirus, enterovirus, influenza A and B, parainfluenza 1C4, and respiratory syncytial virus. The patient was started on intravenous acyclovir 150?mg every 8?h and received his scheduled dose of IVIG infusion. Lubricating eye drops were initiated as well for corneal protection. Entecavir hydrate During admission, a magnetic resonance imaging (MRI) was attempted but could not be completed due to patient movement. The patient was not sedated for the imaging study due to the SARS-CoV2 positive status. Once stable, the patient was discharged on a five-day course of prednisolone and acyclovir. At follow-up in three weeks, the symptoms had improved (House-Brackmann grade: I). 3.?Discussion To our knowledge, this is the first report of an association between Bells palsy and SARS-CoV-2 in a pediatric patient. Few cases of Bells palsy in the setting of SARS-CoV2 infection have been reported in adults and appear to be very infrequent , . In these cases, facial nerve palsy was noted in the setting of fevers and viral symptoms and workup for other typical causes of Bells palsy were negative. Of note, our patient presented with no reported history of viral.