Lyme Disease Facial Palsy Progressed Despite Treatment

Facial palsy may signal neurologic Lyme disease.
Hearing loss and dizziness can also occur.
Symptoms may continue to evolve despite treatment.

Lyme disease facial palsy can worsen despite early treatment—particularly when neurologic symptoms continue to evolve.

In this case report, a 71-year-old man developed progressive facial palsy, hearing loss, dizziness, and gait instability despite multiple courses of antibiotics.

Hareem and colleagues describe the patient’s clinical course and discuss possible factors associated with treatment failure in neurologic Lyme disease.

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Early Symptoms Before Facial Paralysis

The patient was initially treated for an upper respiratory tract infection and prescribed dexamethasone.

He had experienced a tick bite the previous year but did not recall a rash.

One week later, he developed:

• Right-sided ear pain
• Headache
• Dizziness
• Nausea
• Neck pain
• Tinnitus
• Mild facial asymmetry

Lyme disease Western blot testing was positive, and doxycycline treatment was started.

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Facial Palsy Continued to Progress

Despite treatment, the patient returned several days later with complete facial palsy.

According to the authors:

• Headache persisted
• Neck pain worsened
• Hearing loss developed
• Dizziness and nausea continued

Treatment was changed to cefuroxime.

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Hearing Loss and Gait Instability

Two weeks later, the patient’s neurologic symptoms had progressed further.

He continued to experience:

• Gait instability
• Otalgia
• Hearing loss
• Neck pain

Audiology testing revealed:

• 80% hearing loss in the right ear
• 25% hearing loss in the left ear

The patient was prescribed an additional 30-day course of doxycycline.

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Facial Palsy and Neurologic Lyme Disease

Facial palsy may occur in neurologic Lyme disease when inflammation affects the facial nerve.

Some patients also develop:

• Dizziness
• Hearing changes
• Tinnitus
• Balance problems
• Additional cranial nerve involvement

These neurologic symptoms may overlap with other conditions and contribute to delayed recognition.

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Did Steroids Contribute to Worsening Symptoms?

The patient received dexamethasone early in the course of illness before Lyme disease treatment was initiated.

The authors raised concerns regarding possible treatment failure and referenced prior discussions involving steroids in Lyme disease patients.

Questions regarding steroid use in Lyme-associated facial palsy remain an area of ongoing clinical discussion.

Related: Steroids harmful to patients with Bell’s palsy caused by Lyme disease

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Clinical Perspective

The authors described the patient as having chronic neurologic Lyme disease with involvement of the seventh and eighth cranial nerves.

This case highlights several important clinical themes:

• Facial palsy may be an early neurologic sign of Lyme disease
• Hearing loss and dizziness can occur alongside facial paralysis
• Symptoms may continue to evolve despite treatment
• Neurologic Lyme disease may involve multiple cranial nerves

The patient did not receive intravenous ceftriaxone, and alternative treatment approaches were not discussed in detail by the authors.

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Frequently Asked Questions

Can Lyme disease cause facial paralysis?
Yes. Lyme disease can affect the facial nerve and lead to facial weakness or complete facial palsy.

Can Lyme disease affect hearing?
Some patients with neurologic Lyme disease report hearing loss, tinnitus, dizziness, or balance problems.

Are steroids recommended for Lyme facial palsy?
The role of steroids in Lyme-associated facial palsy remains controversial and continues to be discussed in the medical literature.

Reference:

Hareem, A., Dabiri, I., Zaheer, N., & Burakgazi, A. Z. (2021). Medically refractory neuroborreliosis case presented with coexistance involvements of cranial 7 and 8 nerves. Neurology International, 13(1), 125–129.

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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