Bilateral facial palsy associated with leptospirosis

Abstract

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.

Bilateral simultaneous facial palsy following scrub typhus meningitis: A case report and literature review

“…It is most often found in a symptom complex of systemic diseases, including Guillain‐Barré syndrome (GBS), which exists in 0.3% to 2.0% of facial palsy cases [6,7]. Although bilateral facial palsy associated with leptospirosis [5,8] and coinfection of leptospirosis plus scrub typhus [9] has been reported elsewhere, the possibility of leptospirosis in this patient was excluded by the Taiwan CDC.…”

Differential diagnosis of recurrent or bilateral peripheral facial palsy

“…pontine haemorrhage or infarction) 11 , 48 can mimic bilateral peripheral facial palsy. † Borrelia burgdorferi , 17 Treponema pallidum , 11 , 17 , 49 Mycobacterium tuberculosis , 11 Mycobacterium leprae , 11 Mycoplasma pneumoniae , 50 Leptospira interrogans , 51 Clostridium tetani 52 and bacterial otitis caused by other bacteria 11 26 ‡ Epstein– Barré virus, 17 , 28 herpes simplex virus, 53 human immunodeficiency virus, 11 , 17 varicella zoster virus, 28 rubella virus 54 and poliovirus 55 …”

Bilateral facial paralysis associated with leptospirosis

“…Its incidence is related to precarious living conditions, which favor the proliferation of rodents, the main vectors of the disease. Infected rodents eliminate the spirochetes in their urine, which contaminates the rainwater, exposing the human population to the agent, especially during flooding ( 1 ) .…”

“…In addition to laboratory tests—such as a complete blood count, treponemal tests, serology for HIV, serology for Lyme disease, and lumbar puncture, as well as quantification of the blood glucose level, the erythrocyte sedimentation rate, and antinuclear antibodies—and magnetic resonance imaging studies of the brain for the investigation of the involvement of other cranial nerves or other associated findings—a complete physical examination should be performed ( 7 ) . Because leptospirosis is a common entity during times of flooding in Brazil, we must also consider the disease in patients who develop bilateral facial paralysis and we should therefore include specific tests for its diagnosis ( 1 ) .…”

“…Although the pathogenesis of the condition is still not well known, it is believed that Leptospira spp. can cause systemic vasculitis and activate the formation of immunocomplexes ( 1 ) . However, a specific causal relationship between leptospirosis and facial paralysis has yet to be established, and the description of new cases is therefore fundamental for a better understanding of the relationship between the two entities.…”