Rare encounter of unilateral facial nerve palsy in an adolescent with Guillain-Barré syndrome

Abstract

Unilateral facial nerve palsy is rarely encountered in Guillain-Barré syndrome (GBS). We report a case of an adolescent girl who presented with peripheral ascending weakness, preceded byCampylobacter jejuniinfection. After treatment with intravenous immunoglobulin, the peripheral weakness improved. Electro-diagnostic testing confirmed axonal dysfunction and the patient was positive for antiganglioside antibodies. However, the patient developed unilateral left-sided facial weakness. She was managed with further intravenous immunoglobulin and intensive physiotherapy. The outcome for facial palsy was very good, with almost complete resolution after 2 weeks.

Guillain-Barré Syndrome Presenting with Unilateral Peripheral Facial Palsy in an Infant

“…Facial palsy in GBS usually follows limb weakness or at least presents simultaneously with other clinical features of GBS such as limb weakness, dysesthesia, and multiple cranial palsies. Presentation of facial palsy alone as the first symptom of GBS is rare [2][3][4]. There has been one case report of an 11-year-old girl presenting with unilateral facial palsy preceding motor weakness by three days, which is similar to our case [5].…”

“…There has been one case report of an 11-year-old girl presenting with unilateral facial palsy preceding motor weakness by three days, which is similar to our case [5]. Our patient developed bilateral incomplete facial palsy with bulbar palsy while unilateral facial palsy was improving, which showed a different clinical course from the previous pediatric cases [2][3][4][5]. He had no autonomic dysregulations such as labile hypertension, implicating his facial palsy not being related to hypertension.…”

“…Facial palsy in GBS is often bilateral. Unilateral facial palsy is rare, and very few cases have been reported [2,3]. There are a limited number of pediatric GBS cases with unilateral facial palsy described in the literature [4].…”

“…As mentioned before, unilateral facial palsy in GBS is rare, especially in children. Only a few pediatric case reports have been published [3][4][5]. Facial palsy in GBS usually follows limb weakness or at least presents simultaneously with other clinical features of GBS such as limb weakness, dysesthesia, and multiple cranial palsies.…”

“…Anti-GM2 with previous Campylobacter jejuni infection has been linked to bilateral facial paralysis. Iqbal et al [3] reported a case of an adolescent girl with GBS who presented with unilateral facial palsy after C. jejuni infection, who was positive for anti GM1 and GM2 antibodies. Although our patient's stool was positive for C. difficile toxin B and C. perfringens, we could not be certain about the relationship between unilateral facial palsy and the pathogens isolated from the stool.…”