Objective:

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Background:

Bilateral facial nerve palsy is an uncommon neurological presentation, accounting for less than 2% of facial palsy cases. Reported causes include Guillain-Barré syndrome, Lyme disease, sarcoidosis, and infectious etiologies. Of infectious etiologies, HIV infection has been documented as a rare precipitant.

Design/Methods:

Case Presentation: A 34-year-old man presented with one month of progressive bilateral facial weakness and blurry vision, more pronounced on the left. Neurological examination demonstrated upper and lower motor involvement of cranial nerve VII bilaterally, impairing eye closure bilaterally and muscles of facial expression. He did not have any other neurological deficits on the exam. Laboratory studies showed an HIV RNA viral load of 46,400 copies/mL and a CD4 count of 80 cells/μL, confirming a new diagnosis of AIDS. In addition, he was later found to have positive histoplasma with complement fixation titer of 1:8. CSF analyses for HIV, HTLV, Lyme, TB, West Nile Virus, Listeria, Coccidioides, and JC virus were negative. The patient was started on antiretroviral therapy, a ten-day course of valacyclovir, and a seven-day course of corticosteroids, with no significant improvement in facial motor function during hospitalization. 

Results:

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Conclusions:

This case highlights HIV infection as a potential underlying cause of bilateral facial nerve palsy. Clinicians should maintain a high index of suspicion for HIV when evaluating atypical or bilateral cranial neuropathies, as early recognition and treatment can improve outcomes and prevent opportunistic complications.