[A case of facial diplegia due to EB virus infection]

Abstract

A case of facial diplegia due to EB virus infection is reported. A 56-year-old man developed headache, arthralgia and low grade fever. Two days later he noted dysesthesia of the bilateral extremities. Eight days later, disturbances of bilateral mouth and eye closing appeared, which brought him to our hospital on January 6, 1986. Neurological examinations disclosed bilateral peripheral facial palsy and glove and stocking type sensory impairment. Muscle weakness, pathological reflexes were not noted. Examination of CSF on admission revealed a cell count of 63/mm3 and a protein concentration of 45 mg/dl. The lumbar puncture, done 7 days later, revealed a cell count of 17/mm3, and a protein concentration of 41 mg/dl. Serum Epstein-Barr virus titers were times 40 (VCA IgG) and less than X10 (EBNA) on admission. Nine days later, serum EB virus titer increased to times 160 (VCA IgG). He was diagnosed as having polyneuropathy due to EB virus infection from the clinical manifestations and serum antibody titer for EB virus. EB virus infection produces various neurological manifestations. Facial nerve palsy is reported as one of the rare complications. However, most of these cases are associated with Guillain-Barré syndrome (GBS). As far as we know, only 10 cases of bilateral facial nerve palsy in the absence of GBS have appeared in the literature. In our case, bilateral facial nerve palsy appeared as a part of polyneuropathy in the absence of GBS. EB virus should be considered as one of etiologies of bilateral facial nerve palsy.