Bilateral Isolated Facial Paralysis Due to Lyme Disease

Lyme disease, a tick-borne infection caused by the spirochete Borrelia burgdorferi, is a multisystem disease most commonly affecting the skin, joints, nervous system, or heart. Acute neurologic abnormalities occur in 15 to 20% of the patients and neuropathy, particularly facial paralysis, lymphocytic meningitis and motor and sensory radiculoneuritis are the most common manifestations. However, facial paralysis is an objective manifestation of acute neuroborreliosis as it occurs during the early disseminated phase of the infection. The incidence of facial paralysis was reported as 4.5% but isolated facial paralysis with out other clinical manifestations such as headache, neck pain, stiff neck or throat pain due to borreliosis is extremely rare A previously healthy 46-year-old male developed bilateral facial nerve paralysis. The neurological examination was normal except the bilateral facial nerve palsy. Serological investigation of CSF and serum revealed positive Enzyme-linked Immunosorbent Assay (ELISA) for Ig M and Ig G antibodies to B. burgdorferi antigens. An antibiotic regimen consisting of ceftriaxone 2 g/day for six weeks was initiated. The patient was fully recovered at the end of first month with full regression of serological and CSF laboratory findings. In this current case, we report a patient with sole bilateral facial nerve paralysis due to Lyme disease.