Bilateral facial palsy (paralysis or weakness on both sides of the face) is extremely rare and can be caused by an autoimmune condition, infections, such as Lyme disease, or trauma.

Bilateral facial palsy due to Lyme disease has rarely been reported in the literature. A recent article by Cheng and colleagues, entitled “Case Report: A Typical Lyme Disease With Uncommon Neurologic Presentation,”¹ describes a patient who presented with bilateral facial palsy.

The 32-year-old man was admitted to the emergency department with a rash, headache and right-sided facial weakness. He reported initially having a large rash on his abdomen with similar rashes appearing several days later on his legs, trunk and wrists.

“We present a rare case of bilateral facial palsy in Lyme disease due to Borrelia burgdorferi infection.”

“One day before presentation, the patient had difficulty in closing the right eyelid and had drooling from the right corner of the mouth when drinking water,” according to the authors.

The patient, who lived in a wooded area, could not recall a tick bite. While waiting for Lyme disease test results, the man was treated empirically with doxycycline. He later tested positive for Lyme disease.

After 17 days of treatment, his EM rashes and bilateral facial palsy had resolved.

“Although facial nerve palsy is not an uncommon neurologic presentation in the early disseminated stage of the disease, the majority are unilateral. In fact, bilateral facial palsy is an extremely rare condition,” the authors point out.