Waqas Ali, MD, MBBBS
Resident Physician, University of Pittsburgh-McKeesport
UPMC McKeesport
McKeesport, Pennsylvania
Disclosure information not submitted.
Khubaib Ahmad, MBBS
Medical Student
Services Institute of Medical Sciences, United States
Disclosure information not submitted.
Asmi Chattaraj, MD
Resident Physician
University of Pittsburgh- McKeesport, United States
Disclosure information not submitted.
Anjana Pillai, MD
Faculty
University of Pittsburgh- McKeesport, United States
Disclosure information not submitted.
Title: Bell’s Palsy- It can be COVID-19!
Case Report Body:
Introduction:
COVID-19 infection most commonly presents with cough, fever, myalgia and generalized malaise. Neurologic manifestations of COVID-19 infection include headache, encephalopathy, encephalomyelitis, ischemic CVA, intracerebral hemorrhage, GBS and loss of taste & smell. We present an unusual case of Bell's palsy as the initial manifestation of COVID-19 infection in an elderly man.
Description:
84-year-old man with medical history of end-stage renal disease on hemodialysis presented with right-sided facial droop and inability to close right eye. He also reported headache in right temporal and parietal regions radiating to the right side of neck that preceded the onset of facial weakness by 4-5 days. Physical exam was consistent with lower motor neuron type facial palsy. Brain MRI without contrast was unremarkable for any acute infarct and hemorrhage. Diagnosis of Covid-19 was made based on positive SARS-CoV-2 RNA RT-qPCR on nasopharyngeal swab on admission which was done due to ongoing pandemic. At the time of admission, he did not report any respiratory symptoms and was saturating well on room air without any respiratory distress. Lyme’s disease was excluded by negative Lyme serologies and normal ESR excluded temporal arteritis. Patient Bell's palsy was considered to be secondary to COVID-19 infection. The patient was started on a 7-day course of oral Prednisone and Valacyclovir leading to significant improvement in facial weakness. He also received ocular lubricant for supportive care. During the hospital stay, he developed respiratory distress progressing to ARDS requiring mechanical ventilation. Unfortunately, he suffered peri-intubation cardiac arrest and passed away.
Discussion:
Based on our literature review, most of the cases of facial palsy associated with COVID-19 infection have been reported in women. Our case highlights an atypical presentation of this viral disease in an elderly man. Direct viral damage, autoimmune-mediated nerve injury, as well as microthrombi leading to nerve damage, have been postulated as potential mechanisms of facial nerve palsy associated with COVID-19 infection. Treatment strategies for Bell's palsy secondary to COVID-19 remain unexplored and may present as a challenge. Most cases in the literature suggest resolution of symptoms with treatment of COVID-19 infection.