Bell’s palsy due to Lyme disease misdiagnosed, patient bedridden

In their study “Bilateral Facial Nerve Palsy in a Young Woman From West Bengal: Do Not Forget Lyme Neuroborreliosis,” Kayal and colleagues describe the case of a 23-year-old woman, living in India, who was misdiagnosed with bilateral facial nerve palsy. [1]

Until recently, India has been considered a non-endemic region for Lyme disease, the authors point out. And, “Although it had been considered extremely rare in India, a recent study conducted in Nagarahole and Bandipur in South India surprisingly revealed a high seroprevalence (19.9%) of Borrelia burgdorferi infection in a population at risk (forest workers and staff).”

According to the case report, the young woman was admitted to the hospital with “rapidly evolving progressive weakness of all four limbs, and lancinating pain over the back of the neck and lower back, radiating to upper and lower limbs.”¹

Her symptoms had developed over a 1-week period and left the patient bedridden. Ten days prior, she had developed a fever, which resolved within 2 days.

Two months before the onset of symptoms (during the last months of her pregnancy), she developed a “slight deviation of her angle of the mouth toward the left side, along with grossly decreased taste sensation and difficulties in closing eyes, blowing, and whistling.” This lasted for one month.

She was diagnosed with right-sided Bell’s palsy but Lyme disease was not considered, initially.

The woman was treated with methylcobalamine and prednisolone. However, her symptoms did not improve.

Further testing revealed the patient was 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 her discharge from the hospital, the woman was able to walk without assistance. And, at the 6-month follow-up visit, she had “no demonstrable neurological deficit.”

Currently, only 10 cases of Lyme disease have been reported in India. Four of these cases involved lower motor neuron–type facial paresis.

In this case, the patient “also had an asymmetric lower motor neuron–type bilateral facial paresis, which was misdiagnosed by her treating physicians as right-sided Bell’s palsy leading to a delay in diagnosis.”

Interestingly, the authors point out, none of these patients exhibited an erythema migrans (bull’s-eye) rash.

The authors’ suggest:

“The possibility of Lyme neuroborreliosis should be considered more often from now on because in the last year four cases with the kindred clinical syndrome have been described from a so-called “non-endemic zone.”