Facial nerve palsy associated with leptospirosis

Costa, Eduardo; Sacramento, Edilson; Lopes, Antônio Alberto; Bina, José Carlos

doi:10.1590/s0037-86822001000200011

Cited by 8 publications

(8 citation statements)

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“…[12]. As in the cases previously reported [11][12], the development of the facial palsy herein reported occurred in the convalescence period of the immune phase -the fourteenth day in the present studywhen the symptoms of the disease had already decreased. This fact is consistent with the hypothesis that facial paralysis associated to infectious diseases must be mediated by immunological mechanisms.…”

Section: Discussionsupporting

confidence: 83%

“…Other syndromes described include cerobrovascular accidents [5][6], polyneuropathies [7], transverse myelitis [3], Guillan-Barré syndrome [4], mononeuritis multiplex [8][9] and cranial nerve palsies [10][11][12]. However, the occurrence of facial paralysis, especially the bilateral form, is uncommon.…”

Section: Discussionmentioning

confidence: 99%

“…Leptospirosis is an acute feverish disease with a broad clinical spectrum and a characteristic biphasic course (leptospiremia and immune phases). Numerous neurological manifestations have been described during the immune phase [2][3][4][5][6][7][8][9][10][11][12].…”

mentioning

confidence: 99%

“…Unlike unilateral palsy, the bilateral form is rarely considered idiopathic -only 20% of the cases -and frequently indicates a potentially severe subjacent condition [13]. Up to the present, few reports on the association between facial palsy and leptospirosis have been located in the literature [10][11][12], and only one of these previous reports refers to the bilateral form [11].…”

mentioning

confidence: 99%

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Bilateral facial palsy associated with leptospirosis

Silva¹,

Ducroquet²,

Pedrozo³

2009

Braz J Infect Dis

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Leptospirosis is a zoonosis of worldwide occurrence caused by the spirochete Leptospira interrogans. It is an acute feverish disease with a broad clinical spectrum and follows a characteristic biphasic course. Bilateral facial palsy is a rare clinical condition and the differential diagnosis of its causes is extensive. The objective of this exploratory study, presented as a case report, is to describe the occurrence of bilateral facial palsy as an unusual manifestation of leptospirosis. This suggestion should not be overlooked when analyzing the causes for bilateral facial palsy, and should be considered with other possible differential diagnoses, some of which are potentially fatal.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Bilateral facial palsy associated with leptospirosis

Silva¹,

Ducroquet²,

Pedrozo³

2009

Braz J Infect Dis

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“…This complication in our patient occurred in the convalescent phase of the disease as in previously reported cases [ 3 - 5 ]. Costa E et al shown that leptospirosis patients developed facial nerve palsy approximately on the ninth day of symptomatic disease, when the clinical manifestations attributed to leptospirosis had subsided [ 16 ]. This was also consistent with the idea that facial palsy in patients with infectious disease is mediated by an immunological mechanism [ 16 , 17 ] which is yet to be understood.…”

Section: Discussionmentioning

confidence: 99%

Co-existent facial palsy and myocarditis in a 50-year old farmer diagnosed with probable leptospirosis: a case report

Kumarihamy¹,

Ralapanawa

Jayalath

2015

BMC Res Notes

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BackgroundLeptospirosis is a worldwide zoonotic disease caused by spirochetes belonging to the genus Leptospira. This is a case report on a patient with probable leptospirosis, who developed lower motor neuron facial nerve palsy during the recovery phase of this illness. Leptospirosis is endemic in Sri Lanka and this complication has been reported earlier in other countries but not in Sri Lanka to the best of our knowledge.Case presentationA previously well 50 year old Sinhalese farmer in Sri Lanka was admitted to a tertiary care hospital with five day history of fever, headache, prostration, severe myalgia especially in the calves and yellowish discoloration of the eyes. He was febrile, icteric and had suffusion of both conjunctivae. His pulse rate and blood pressure was 98/min and 90/50 mmHg respectively. The initial laboratory examinations showed neutrophil leukocytosis and thrombocytopenia. Antibodies test for leptospirosis was done and IgM was positive. Because of this evidence the probable diagnosis of leptospirosis was made and antibiotic therapy initialed with intravenous cefotaxime 1 g 8 hrly and crystalline penicillin 2 mu 6 hrly.On the eighth day he developed chest pain associated with shortness of breath with a heart rate of 120/min. Electrocardiograpic and echocardiograpic evidence suggested myocarditis, and trponin I titer was positive. Supportive care was provided and antibiotics were continued.On the 13th day of illness he developed lower motor type facial nerve palsy of the left side with positive Bell’s phenomenon. But rest of the neurological examination was normal. He was discharged on a step-down course of prednisolone and physiotherapy. He fully recovered from cardiac involvement before discharge but recovery from facial nerve palsy took place only six months later.ConclusionOur case emphasizes cardiac and facial nerve involvement in leptospirosis. This is the first published report in Sri Lanka of facial nerve palsy occurring in leptospirosis possibly due to immunological damage. Further literature survey revealed that this is the first case in the world with simultaneous occurrence of myocarditis and facial nerve palsy in leptospirosis. The pathogenesis of this occurrence is yet to be fully understood.

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