Bilateral peripheral facial palsy secondary to lymphoma in a patient with HIV/AIDS: a case report and literature review

Abstract

Neurological complications represent one of the most important causes of morbidity and mortality in patients with HIV/AIDS. However, peripheral neuropathy comprises only 5% to 20% of the total neurological complications and facial nerve palsy, especially when it is bilateral, is a less common manifestation. Peripheral facial palsy has been considered as a possible neurological complication of the early stage of HIV infection but the number of reported cases in the literature is limited. Histological findings of nervous tissue in peripheral facial palsy at an early stage of HIV infection include a degenerative and not suppurative inflammatory process, but its etiology remains obscure. Peripheral facial palsy in the late stage of HIV infection is characterized by an advanced immunological deficit and generally it is secondary to an opportunistic infection of the CNS, such as neurotoxoplasmosis and lymphoma. However, this peripheral attack of the facial nerve is not very common at this late stage of HIV infection. Bilateral peripheral facial palsy as a complication of non-Hodgkin s lymphoma is considered an extremely rare entity. There are no published reports of bilateral peripheral facial palsy secondary to lymphomas or other neoplasms of the CNS in immunosuppressed patients. Non-Hodgkin s lymphoma (NHL) has been considered a late and relatively common manifestation of HIV infection, but an exact cause for the higher incidence of this malignant neoplasm in HIV/AIDS patients is still uncertain.

Lymphoma and peripheral neuropathy: A clinical review

“…3,24,64,100 Some of these are associated with HIV infections or other disorders that depress the immune system. 42,114,150 These neoplasms can infiltrate cranial nerves, 38,45,97 roots, 100 plexuses, 62,71,123 and peripheral nerves, often ex-tending from regional foci of disease or by hematogenous dissemination. 100,119 They can also infiltrate peripheral nerves and cause a mononeuropathy or regional, asymmetric pattern suggesting vasculitic neuropathy.…”

Burkitt's non-Hodgkins lymphoma presenting as facial nerve palsy in HIV-positive patients

“…In contrast, facial nerve palsy in the later stages of HIV is usually secondary to opportunistic infection of the central nervous system (CNS) or malignancy. 2 The three patients presented in this case series had later stage HIV and a persistent facial paralysis, which should signal the need for further investigations.…”

Multiple cranial nerve palsies in immunodeficiency subtype of Burkitt lymphoma

“…Paralysis can occur before the appearance of antibodies against HIV antigen. The etiology remains unclear, but may be due to the virus itself or it may be secondary to other infections like herpes simplex virus, adenovirus, mumps, and rubella [2]. …”

“…Burkitt Lymphoma is a late complication of HIV, and bilateral cranial nerve palsies are extremely rare in patients with AIDS [2]. We present what we believe is the first reported case of Burkitt Lymphoma presenting with bilateral facial, vestibulocochlear, left abducens, and mandibular nerve palsies.…”