Bell’s palsy during interferon alpha 2a treatment in a case with Behçet uveitis

Abstract

Purpose: To present a case who developed Bell’s palsy while using interferon alpha 2a for Behçet uveitis. Methods: A patient with Behçet disease presented with decreased vision in his right eye. Ophthalmic examination, fundus fluorescein angiography and optical coherence tomography were performed. After developing facial paralysis while on interferon therapy, the patient was referred to our neurology service for differential diagnosis and treatment. Results: Examination of right eye revealed panuveitis with branch retinal vein occlusion, so high dose steroids were prescribed. In three days there was no improvement in terms of vitreous inflammation and so steroids were replaced with interferon. At the seventh month, patient experienced a facial paralysis. After eliminating other causes, including viral infections, trauma, cold exposure and neurological evaluation with cranial MRI, the patient was diagnosed to have Bell’s palsy by a neurologist. Interferon was replaced with mycophenolate mofetil and the Bell’s palsy was treated with oral steroids. Conclusion: It is important to be alert to both common and rare complications while treating with interferon.

Bell's palsy and SARS-CoV-2 vaccines

“…Such interferon production could transiently break peripheral tolerance, a hypothetical phenomenon invoked in several case reports. 8,9 We conclude with a consideration of the statistical and epidemiological implications of reported safety data of the SARS-CoV-2 vaccine trials. Publicly available data from the Pfizer-BioNTech and Moderna vaccine trials suggest an imbalance in the incidence of Bell's palsy following vaccination compared with the placebo arm of each trial.…”

Bell’s Palsy Following SARS-CoV-2 Vaccines: A Systematic Review and Meta-Analysis

“…SARS-CoV-2 vaccines, however, do not contain adjuvants that mediate the immune response. Instead, the virus mRNA in the vaccines might interact with the immune cellular membranes and elicit an innate immune response (102), which in turn may trigger BP similar to the cases reported with interferon treatment (110, 111).…”

Left Bell's palsy following the first dose of mRNA-1273 SARS-CoV-2 vaccine: A case report

“… 14. , 15. Another possible etiopathogenesis is the reactivation of latent Herpes Simplex Type 1 infections of the geniculate ganglia of facial nerves: a previous study by Murakami et al on 14 patients with Bell's palsy, 9 patients with the Ramsay-Hunt syndrome, and 12 controls, demonstrated the presence of Herpes simplex virus type 1 genomes in the 79% of Bell's palsy patients, but not in patients with the Ramsay-Hunt syndrome or in other controls.…”

“…13 A second theory is that the vaccine causes innate immune activation by a combination of mRNA and lipids, which could include interferon synthesis, exceeding the peripheral tolerance. 14,15 Another possible etiopathogenesis is the reactivation of latent Herpes Simplex Type 1 infections of the geniculate ganglia of facial nerves: a previous study by Murakami et al on 14 patients with Bell's palsy, 9 patients with the Ramsay-Hunt syndrome, and 12 controls, demonstrated the presence of Herpes simplex virus type 1 genomes in the 79% of Bell's palsy patients, but not in patients with the Ramsay-Hunt syndrome or in other controls. 16 If this hypothesis is confirmed by future studies, previous Herpes Simplex Virus 1 infection should be considered as a risk factor for the development of post-vaccine Bell's palsy.…”