Hypoglossal nerve palsy in infectious mononucleosis and Fusobacterium necrophorum tonsillitis: a case report and literature review

Background: Hypoglossal nerve palsy (HNP), although rare, can result from various causes and more commonly in children is secondary to infectious etiologies. Its optimal management requires accurate diagnosis and exclusion of severe complications like Lemierre’s syndrome, vascular events, tumors, or demyelination/inflammatory processes). Case presentation: A previously healthy 16-year-old boy was diagnosed with HNP, infectious mononucleosis and Fusobacterium necrophorum tonsillitis. The patient presented with fever, neck swelling, and swallowing difficulty, accompanied by left-side tongue deviation. Prompt treatment with clindamycin and prednisone led to rapid improvement of symptoms (within 5 days) and complete recovery after 4 weeks. Conclusions: This case highlights the importance of considering uncommon neurological complications in patients with common diseases. An extensive literature review on HNP in childhood was conducted, summarizing the diverse etiologies, clinical presentations, diagnostic tests, and treatment approaches.