Can Lyme Disease Cause Bilateral Facial Palsy?
“My face started drooping—then both sides were affected.”
Facial palsy is often assumed to be a viral condition such as Bell’s palsy.
Quick Answer: Lyme disease can cause facial paralysis on both sides of the face (bilateral facial palsy), although this presentation is rare.
Clinical Insight: Bilateral facial palsy is uncommon and should prompt evaluation for underlying causes, including infections such as Lyme disease.
When facial palsy is not typical
A 32-year-old man presented with a rash, headache, and right-sided facial weakness.
He initially developed a large rash on his abdomen, followed by additional rashes on his legs, trunk, and wrists.
One day before evaluation, he had difficulty closing his right eyelid and noted drooling when drinking.
These symptoms were consistent with early facial nerve involvement.
Progression to bilateral facial palsy
Facial palsy in Lyme disease is typically unilateral.
In this case, however, the patient developed bilateral facial involvement—an uncommon presentation.
“We present a rare case of bilateral facial palsy in Lyme disease due to Borrelia burgdorferi infection,” the authors reported.
This pattern is important because bilateral facial palsy is more likely to signal an underlying systemic condition rather than an isolated nerve disorder.
Why Lyme disease may be missed
The patient lived in a wooded area but did not recall a tick bite.
This is common in Lyme disease.
Without a known tick exposure, clinicians may not immediately consider Lyme disease.
These patterns reflect why Lyme disease can be difficult to diagnose.
Diagnosis and treatment
The patient was treated empirically with doxycycline while awaiting test results.
Lyme disease was later confirmed.
After 17 days of treatment:
- The rash resolved
- The bilateral facial palsy improved
This response supports the importance of early recognition and treatment.
How common is bilateral facial palsy?
Facial nerve palsy is a recognized neurologic manifestation of Lyme disease.
However, most cases involve only one side of the face.
Bilateral facial palsy is extremely rare and should raise suspicion for conditions such as Lyme disease, autoimmune disorders, or systemic infections.
Clinical takeaway
Facial paralysis affecting both sides of the face is not typical.
When this pattern occurs, Lyme disease should be considered—especially in endemic areas.
Early treatment can lead to full recovery.
Frequently Asked Questions
Can Lyme disease cause facial paralysis?
Yes. Lyme disease can affect the facial nerve and lead to facial palsy.
Can Lyme disease affect both sides of the face?
Yes, but this is rare. Bilateral facial palsy is an uncommon presentation of Lyme disease.
Is bilateral facial palsy serious?
Yes. It often indicates an underlying systemic condition and should be evaluated promptly.
Can Lyme facial palsy improve with treatment?
Yes. Many patients improve with appropriate antibiotic therapy.
Related Reading
- Neurologic Lyme Disease
- Facial Paralysis Misdiagnosed as Viral
- Facial Palsy and Treatment Challenges
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I had bilateral facial palsy from Lyme disease, By the time I went to hospital ,which was several days after the palsy appeared only one side of my face was dropped. The doctor did not believe me that I had belles palsy on both sides of my face. I did text positive for Lyme disease, but I never had a rash.
I understand bilateral Bell’s is more likely to be Lyme disease than unilateral.