Facial Paralysis Due to Brazilian Lyme Disease: A Case Report and Literature Review

Abstract

Lyme disease (LD) is a highly prevalent infection in the northern hemisphere, with an estimated incidence of 450,000 new annual cases in the United States and 65,000 new annual cases in Europe. Transmitted by the bite of a tick contaminated with a spirochete, the disease has three distinct stages. In the second phase of the disease, there may be neurological impairment, and the involvement of cranial nerve pairs occurs in this phase. Neuropathy of the seventh cranial nerve can occur in around 10% of adults with neurological involvement by Borrelia; in children, this incidence can reach 50%. A 32-year-old female patient presented with an abrupt facial paralysis that evolved into a difficult-to-resolve condition. With the appearance of probable contralateral involvement, LD was diagnosed. After the established treatment, the patient presented a good evolution of the symptoms.

Keywords: bell's palsy; borrelia burgdorferi infection; facial paralysis; lyme borreliosis; lyme disease.

Figure 1. Contrast-enhanced axial MRI performed in February 2022 demonstrates abnormal enhancement of the right facial nerve (blue arrow). The left facial nerve (red arrow) is normal.

Figure 2. Contrast-enhanced axial MRI performed in October 2022 demonstrates abnormal enhancement of the right facial nerve (blue arrow) and left facial nerve (red arrow).

Figure 3. Contrast-enhanced axial MRI performed in February 2023 demonstrates normal right facial nerve (blue arrow) and normal left facial nerve (red arrow).