Left-sided facial swelling and paralysis in a 2- month-old Girl

Left-sided facial swelling and paralysis in a 2- month-old Girl

Introduction: Unilateral facial nerve paralysis has a broad differential in pediatric patients, ranging from congenital, zoonotic, infectious, and iatrogenic causes. With this differential, a proper work up is needed to rule out causes that can be detrimental to the child’s health if left untreated.

Case Presentation: A previously healthy 2-month-old full term female presented to the Emergency Room for concern of left sided facial paralysis and swelling. On history mom denied recent illness, any exposure to animals or insects, recent camping or hiking trips, and birth history was reassuring. On physical exam the patient was noted to be alert and attentive, and both of her pupils were reactive to light with normal conjunctiva. While the patient was calm and resting, it was noted that her left eye remained open whenever the right eye would blink. Mild asymmetry was also noted in the patient’s smile. When she was made to cry, the patient’s left eye remained completely open, the left portion of the forehead remained stiff compared to the right and left sided oral droop with loss of nasolabial folds was noted. Neurological exam was also significant for a weak suck reflex, but the remainder of reflexes were all noted to be within normal limits. On admission, the patient received a full work up including COVID, lumbar puncture with meningitis/encephalitis panel, urinalysis, CMV, HSV, and Lyme which were all found to be negative. MRI was significant for enhancement within the region of the facial nerve at the geniculate ganglion, and ultimately the diagnosis of Bell’s Palsy was made. The patient was treated with a 5-day taper course of Prednisone. At the time of discharge, she was noted to have improvement in her symptoms.

Discussion: This case illustrates an uncommon presentation of an infant with Bell’s Palsy and the importance of a good history, a thorough physical exam, and focused work up to properly diagnose the cause of unilateral facial nerve and adequately treat the patient.