Facial paralysis as a result of Lyme disease initially attributed to a virus

Of their article “Bilateral facial paralysis: an atypical presentation of Lyme disease,” Collignon and colleagues describe the case of a 35-year-old man who was admitted to the hospital complaining of disabling again ache, which was preceded by facial paralysis.¹

The affected person was admitted to the emergency division for acute again ache that had been progressively worsening over an 8-week interval. The ache started 5 weeks after a minor browsing accident. Repeated X-rays and extra assessments had been regular.

“The depth of the ache is larger at evening and the affected person sleeps little. These pains are described as intense burns.”

At his session, the facial paralysis was unilateral however inside 48 hours, it had progressed to bilateral. His major care doctor attributed the Bell’s palsy to a virus.

“The affected person had not been overly involved as a result of the attending doctor had reassured the affected person that the situation was trivial,” the authors state.

Three months earlier the affected person had been bitten by mosquitoes and probably a tick.

He additionally had an erythema migrans rash in his armpit 4 weeks earlier than the onset of his signs. Nonetheless, clinicians attributed the rash to “sweat-related rubbing.”

Subsequent testing for Lyme disease was optimistic and the person was handled efficiently with 14 days of IV Ceftriaxone.

“After a couple of days, there’s an enchancment in signs each when it comes to paralysis and ache,” the authors state. “After 4 weeks, the neurological examination normalized with full restoration from diplegia.”

The authors level out, “The final practitioner who examined our affected person initially with unilateral facial paralysis had wrongly concluded that he had a chilly paralysis with out every other evaluation.”

Moreover, they counsel, Lyme disease could be troublesome to diagnose with different shows. “Solely an intensive historical past and an in depth medical examination may restrict diagnostic error, significantly within the neurological injury of this illness.”