Bell’s Palsy Due to Lyme Disease Misdiagnosed, Patient Bedridden
Misdiagnosing Lyme disease as Bell’s palsy can lead to severe neurologic complications if the infection is not treated promptly. This case illustrates how delayed recognition of Lyme neuroborreliosis left a young woman bedridden for months before appropriate treatment was started.
Until recently, India has been considered a non-endemic region for Lyme disease. However, the authors note that “although it had been considered extremely rare in India, a recent study conducted in Nagarahole and Bandipur in South India revealed a surprisingly high seroprevalence (19.9%) of Borrelia burgdorferi infection in at-risk populations such as forest workers.”
This finding challenges geographic assumptions about where Lyme disease occurs—assumptions that contributed directly to this patient’s delayed diagnosis and prolonged disability.
Initial Presentation: Facial Palsy Misdiagnosed
According to the case report, a young woman was admitted to the hospital with rapidly evolving weakness of all four limbs and severe lancinating pain radiating from the neck and lower back into the arms and legs.
Her symptoms developed over one week and eventually left her bedridden. Ten days earlier she had experienced a brief fever that resolved within two days.
Two months before the neurologic deterioration—during late pregnancy—she developed facial weakness with deviation of the mouth, decreased taste sensation, and difficulty closing her eyes and whistling.
She was diagnosed with right-sided Bell’s palsy, but Lyme disease was not considered.
Failed Treatment and Progressive Deterioration
The patient was treated with methylcobalamin and prednisolone. However, her symptoms did not improve.
Bell’s palsy typically improves with corticosteroids. When facial paralysis fails to respond to standard therapy, alternative diagnoses—including infectious causes such as Lyme disease—should be investigated.
Instead, the patient continued to deteriorate. Her facial palsy progressed to severe quadriparesis with intense radicular pain, leaving her bedridden.
Diagnostic Testing Reveals Lyme Disease
Further evaluation eventually revealed that the patient tested positive for Lyme disease by ELISA and PCR.
She was treated with intravenous ceftriaxone (2 g/day) and oral azithromycin (500 mg/day) for 14 days.
Three months after hospital discharge, the patient was able to walk without assistance. At the six-month follow-up visit she had no demonstrable neurological deficits.
Her dramatic improvement following antibiotic therapy confirmed that the underlying diagnosis was Lyme neuroborreliosis rather than idiopathic Bell’s palsy.
Why Geographic Bias Delayed Diagnosis
Only about ten cases of Lyme disease have been reported in India, and four involved facial nerve palsy.
In this case, the patient developed bilateral lower motor neuron–type facial paresis that was initially misdiagnosed as unilateral Bell’s palsy.
Interestingly, none of the reported patients had the classic erythema migrans rash.
The belief that Lyme disease is extremely rare in India discouraged physicians from testing for the infection despite the patient’s neurologic symptoms.
Emerging Recognition in Non-Endemic Zones
The authors emphasize that Lyme neuroborreliosis should be considered even in regions traditionally viewed as non-endemic.
Recent seroprevalence studies showing nearly 20% infection rates among forest workers suggest that Lyme disease may be substantially underrecognized in India.
Rather than representing a newly emerging infection, Lyme disease in these areas may simply have gone undetected for years.
Clinical Implications for Facial Palsy Evaluation
Bell’s palsy is often treated as idiopathic facial nerve paralysis. However, when facial palsy occurs with systemic symptoms, neurologic deficits, or poor response to treatment, clinicians must evaluate infectious causes.
This patient had multiple warning signs that should have prompted Lyme testing:
- Facial palsy during pregnancy
- Progression to bilateral facial weakness
- Systemic symptoms including fever
- Development of limb weakness and radicular pain
- Failure to improve with corticosteroids
Together, these findings strongly suggested an infectious neurologic disorder requiring antibiotic therapy.
Clinical Takeaway
Misdiagnosing Lyme disease as Bell’s palsy delayed treatment and left this patient bedridden with progressive neurologic disease. Once Lyme neuroborreliosis was recognized and treated with antibiotics, she recovered fully within months.
This case highlights the dangers of relying on geographic assumptions when evaluating tick-borne illness. Lyme disease should be considered in patients presenting with facial palsy and neurologic symptoms—even in regions traditionally labeled “non-endemic.”
