Bell’s palsy and hepatitis infection

Abstract

Bell's palsy is an acute unilateral facial nerve palsy that is not associated with other cranial neuropathies or brain system dysfunction. The incidence is approximately 3 -10/100 000 population per year. The right and left sides of the face are equally affected in most cases. Recovery is generally complete in 70 -80% of patients after several months of paralysis. Although the etiology is unclear in Bell's palsy, it is believed to be postinfectious, allergic or immune demyelinating facial neuritis. The preceding infectious agents may be Borrelia burgdoferi , Epstein Barr virus (EBV) , Herpes simplex virus (HSV) , Mycoplasma pneumoniae , Varicella zoster virus (VZV) , Trichinella spiralis , Mumps , and Mycobacterium tuberculosis . 1 Here, the authors report a patient with Bell's palsy who also has hepatitis A and chronic hepatitis B virus (HBV) infection. Case reportA 4-year-old girl was referred to Eskisehir Osmangazi University Faculty of Medicine because of right facial nerve palsy, maculopapular rash, fever and abdominal pain. At 10 days before admission she had a history of fever and her parents observed that she could not close her right eye and that their was facial asymmetry when she cried or smiled. She was given oral prednisolone therapy in another hospital for Bell's palsy but no improvement was observed and she developed pururitic macular rash 7 days later. She was born at full term after an uncomplicated pregnancy by spontaneous vaginal delivery. Perinatal history was unremarkable and developmental milestones were appropriate for her age. The healthy parents were fi rst degree relatives. Physical examin ation revealed that blood pressure was 100/60 mmHg, pulse rate was 122 beats/min, and temperature was 37°C. Her sclerae were icteric and there was macular rash on the trunk. Hepatomegaly was present. Neurologic examination revealed that there was asymmetry with droop of corner of mouth on the right side of the face, she was unable to close the right eye. Fundoscopic examination was normal. Muscle tonus and strength were normal. Deep tendon refl exes were normoactive. There was no meningeal irritation signs. Laboratory fi ndings were as follows: hemoglobin, 12.8 g/dL; hematocrit, 38.3%; white blood cells, 11 400/mm 3 ; platelets, 273 000/mm 3 ; sedimentation rate, 30 mm/h; prothrombin time, 12.8 s; partial thromboplastin time, 26.2 s, fibrinogen level, 263 mg/dL; complement C3, 59.4 mg/dL; and C4, 11 mg/dL. Peripheral blood smear showed 72% neutrophils, 28% lymphocytes and atypical lymphocytes were absent. Her serum alanine aminotransferase (ALT), aspartate aminotransferase, C-reactive protein, total bilirubin, direct bilirubin, albumin values were 2693 IU/L, 3946 IU/L, 0.42 mg/dL, 7 mg/dL, 6.67 mg/dL and 4.8 g, respectively. Urinalysis revealed a specifi c gravity of 1.009, pH 6.5, 2+ bilirubin and urobilinogen but no blood, aseton and glucose. Serologic evidence of viruses including anti-hepatitis A virus (HAV) IgG and IgM levels were positive (anti HAV IgM 5.38 IU/mL and cut-off range 0.8 -1.20 IU/mL...

Childhood Hepatitis A Virus Infection Complicated by Bell's Palsy

“…Performing a thorough Medline search, we identified 2 such reports. Yildiz et al 10 described a 4-year-old girl with chronic HBV infection who developed superadded HAV infection complicated by Bell's palsy. There was complete resolution of the facial palsy in 2 months.…”

Bilateral facial nerve palsy: A rare association with hepatitis A

“…[123] A recent review on the prevalence of serological markers of hepatitis, cytomegalovirus and rubella in patients with Bell's palsy revealed a serological positivity for hepatitis B in 15 out of 21 patients (71%) as against 32.1% positivity in the control group. No relation was noted in the above study with hepatitis A serological positivity.…”