Infectious Mimics of Bell's Palsy: Facial Nerve Palsy Due to Lyme Neuroborreliosis

TL;DR

This paper presents a case where facial nerve palsy was caused by Lyme disease, highlighting the need for thorough evaluation to avoid misdiagnosis.

Contribution

The paper adds a clinical case emphasizing the importance of considering Lyme neuroborreliosis in facial palsy diagnosis.

Findings

A 47-year-old man with bilateral facial nerve palsy was diagnosed with Lyme neuroborreliosis.

Treatment with IV ceftriaxone led to significant improvement in facial nerve function.

Normal MRI findings did not rule out neuroborreliosis, underscoring the need for CSF analysis and serology.

Abstract

Facial nerve palsy (FNP) is a common neurological disorder. There are multiple causes of FNP, and Bell’s palsy is defined as an idiopathic cause of FNP. If a patient presents with facial palsy, a full investigation workup should be performed. Lyme disease can present with erythema migrans, fever, headache, muscle and joint pain, and facial palsy. We present a case of a 47-year-old man who presented with progression from unilateral to bilateral FNP. After a series of investigations, he was diagnosed with LNB. Even if MRI findings are normal, cerebrospinal fluid (CSF) analysis and Lyme serology (enzyme-linked immunosorbent assay followed by Western blot) in serum and/or CSF can confirm the diagnosis of neuroborreliosis. We have administered the patient IV ceftriaxone 2 g daily, as per the guidelines. He showed gradual improvement in FNP from House-Brackmann Grade V to Grade II on subsequent follow-ups. This case emphasizes the importance of broad clinical evaluation in diagnosing FNP. Early detection of LNB and initiation of treatment can ensure patients have a favorable outcome.

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