Bilateral facial nerve palsy associated with Epstein-Barr virus infection

Coddington, C T; Isaacs, John D.; Siddiqui, A. M.; Andrews, Timmeka

doi:10.1136/jnnp.2009.195313

Cited by 15 publications

(9 citation statements)

References 6 publications

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“…Of note, however, the presentation of bilateral facial palsy has been γ-GT, γ-glutamyl transferase; AFP, α-fetoprotein; ALP, alkaline phosphatase; ALT, alanine aminotransferase; ANA, antinuclear antibodies; AMA, antimitochondrial antibodies; APTT, activated partial thromboplastin time; AST, aspartate aminotransferase; BUN, blood urea nitrogen; CEA, carcinoembryonic antigen; ChE, cholinesterase; CMV, cytomegalovirus; CRP, C-reactive protein; D-Bil, direct bilirubin; EBV, Epstein-Barr virus; EBNA, EBV nuclear antigen; HAV, hepatitis A virus; HBsAg, hepatitis B surface antigen; HBc, hepatitis B core; HCV, hepatitis C virus; HEV, hepatitis E virus; HSV, herpes simplex virus; LDH, lactate dehydrogenase; RBC, red blood cell count; T-Bil, total bilirubin; T. chol, total cholesterol; VCA, viral capsid antigen; WBC, white blood cell count. reported in patients with infections of other viruses, such as human immunodeficiency virus, Japanese encephalitis virus or EBV; similar but unilateral changes have also been reported in EBV-infected patients with Bell's palsy (Coddington et al 2010;Ruiz and Kirmani 2012;Verma and Praharaj 2012). Therefore, it seems likely that bilateral facial palsy occurs as an extrahepatic manifestation of HEV infection.…”

Section: Discussionmentioning

confidence: 70%

Characteristics of 20 Patients with Autochthonous Acute Hepatitis E in Hokkaido, Japan: First Report of Bilateral Facial Palsy Following the Infection with Genotype 4 Hepatitis E Virus

Yazaki

Sugawara²,

Honda

et al. 2015

Tohoku J. Exp. Med.

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Autochthonous hepatitis E is increasingly being recognized in industrialized countries, including Japan. Although neurological abnormalities have been sporadically reported as an extrahepatic manifestation of hepatitis E virus (HEV) infection, it is rare and has not been reported in Japan. The present study aimed to characterize a total of 20 patients consecutively diagnosed with sporadic acute hepatitis E at a city hospital in Hokkaido, Japan, during 2001-2014, focusing on a patient complicated with neuropathy. Seventeen patients were infected with genotype 4 HEV, while the remaining three patients were with genotype 3 HEV. Although a 67-year-old male with severe hepatitis did not have predisposing factors associated with the development of neurological disorders, such as diabetes mellitus and the use of immunosuppressive agents, he developed bilateral peripheral facial palsy six days after admission. A neurological examination revealed the inability to smile, frown, close his eyes completely or puff out his cheeks. MRI brain scans were considered to be normal. Although it took 83 days after admission for the total bilirubin levels to normalize, his neurological symptoms resolved gradually within three weeks without any sequelae following conservative therapy. A full-length genomic analysis of the HEV strain (HE-JA30) isolated from the patient belonged to genotype 4 and was closest to that currently circulating in Hokkaido, Japan. This is the first report of HEV-associated neuropathy in Japan. While all of previous reports on HEV-related neuropathy involve genotype 3 HEV, the present report is unique in that genotype 4 HEV is responsible for the neuropathy.

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Section: Discussionmentioning

confidence: 70%

Characteristics of 20 Patients with Autochthonous Acute Hepatitis E in Hokkaido, Japan: First Report of Bilateral Facial Palsy Following the Infection with Genotype 4 Hepatitis E Virus

Yazaki

Sugawara²,

Honda

et al. 2015

Tohoku J. Exp. Med.

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“…There are several conditions identified as potential causes, including infections (Lyme disease, EBV, human immunodeficiency virus), inflammatory disorders (sarcoidosis), tumoural (brainstem tumours) and idiopathic (bilateral Bell's palsy) disorders. EBV infection is responsible for 0.5%–7.5% of peripheral facial palsies, and up to 35% are bilateral [2,3]. This patient had serological evidence of recent EBV infection, although PCR for EBV in the CSF was negative.…”

Section: Discussionmentioning

confidence: 99%

Bilateral facial nerve palsy associated with COVID‐19 and Epstein–Barr virus co‐infection

Muras

Carmona-Abellán

Fernández

et al. 2020

Euro J of Neurology

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A 20‐year‐old male, with no relevant previous medical history, was admitted due to bilateral facial weakness. Two weeks before, he noticed odynophagia and fever of 39ºC without cough. He associated significant asthenia with headache, myalgia, nausea, and vomiting and he was treated with levofloxacin 500mg qd for 7 days. One week after, during an initial improvement of the respiratory symptoms, he presented acute right facial weakness. He was diagnosed with right peripheral facial palsy and was treated with prednisone 60 mg/24h with a tapering schedule.

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“…It has been well documented that acute EBV infections in the pediatric age group cause FNP, but few cases have been reported in the adult population [14]. Positive EBV serological tests have been reported in patients with Bell's palsy.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Facial Nerve Palsy: A Diagnostic Dilemma

Pothiawala

Lateef²

2012

Case Reports in Emergency Medicine

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Introduction. Bilateral facial nerve palsy (FNP) is a rare condition, representing less than 2% of all cases of FNP. Majority of these patients have underlying medical conditions, ranging from neurologic, infectious, neoplastic, traumatic, or metabolic disorders. Objective. The differential diagnosis of its causes is extensive and hence can present as a diagnostic challenge. Emergency physicians should be aware of these various diagnostic possibilities, some of which are potentially fatal. Case Report. We report a case of a 43-year-old female who presented to the emergency department with sequential bilateral facial nerve paralysis which could not be attributed to any particular etiology and, hence, presented a diagnostic dilemma. Conclusion. We reinforce the importance of considering the range of differential diagnosis in all cases presenting with bilateral FNP. These patients warrant admission and prompt laboratory and radiological investigation for evaluation of the underlying cause and specific further management as relevant.

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Bilateral facial nerve palsy associated with Epstein-Barr virus infection

Cited by 15 publications

References 6 publications

Characteristics of 20 Patients with Autochthonous Acute Hepatitis E in Hokkaido, Japan: First Report of Bilateral Facial Palsy Following the Infection with Genotype 4 Hepatitis E Virus

Characteristics of 20 Patients with Autochthonous Acute Hepatitis E in Hokkaido, Japan: First Report of Bilateral Facial Palsy Following the Infection with Genotype 4 Hepatitis E Virus

Bilateral facial nerve palsy associated with COVID‐19 and Epstein–Barr virus co‐infection

Bilateral Facial Nerve Palsy: A Diagnostic Dilemma

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