Facial nerve paralysis in Lyme borreliosis in a child (clinical case)
DOI:
https://doi.org/10.15574/SP.2025.1(145).126130Keywords:
non-erythematous form of borreliosis, neuroborreliosis, neuritis, facial nerve, childrenAbstract
Lyme disease is an infectious disease caused by bacteria of the Borrelia burgdorferi complex. Skin lesions in the acute stage occur in most patients, and nervous system lesions are the second most common in Europe and the third after lesions of large joints.
Aim - to demonstrate the features of the clinical course, diagnosis and treatment of neuroborreliosis using the example of a case of facial palsy in a 13-year-old girl.
Clinical case. The patient was admitted to the hospital with complaints of a feeling of heaviness and numbness of the face, difficulty chewing food, speech disorders, difficulty smiling, incomplete closure of the right eyelid and dryness in it, partial loss of taste, increased irritability, emotional lability. These complaints appeared acutely for 2 days, they were preceded by the pain behind the right ear and the child was consulted by an ENT specialist, who ruled out acute otitis. The epidemiological history was unremarkable. On examination: general condition of moderate severity due to neurological symptoms - the child does not delay the air in the mouth when pressured from the outside, the right corner of the mouth does not move when smiling. The eyebrows are frowned, but on the affected side she can not raise an eyebrow. The nasolabial fold is smoothed on the right side, the corner of the mouth is lowered and the eyelid is lowered on the right side, there is asymmetry of the smile, the inability to completely close the eye. Laboratory tests excluded the herpesvirus etiology of the disease and were obtained positive results for antibodies to Borrelia by enzyme-linked immunosorbent assay (ELISA) - IgG and IgM, which were confirmed by Western Blot. The final diagnosis was made: Lyme borreliosis, early disseminated stage, facial nerve paralysis, moderate severity. Antibiotic therapy was prescribed for 28 days, nonsteroidal anti-inflammatory drugs (NSAIDs), vitamin B complex, artificial tears. The treatment was effective and and contributed to the improvement of the general condition of the child.
Conclusions. The difficulties of diagnosing Borreliosis in this case are due to the denial of the fact of a tick bite, the absence of clinical symptoms in the early stage and a monosymptom in the form of damage to only the facial nerve on the right side.It is important to detect the disease in time to prevent complications (involuntary muscle spasms, their atrophy, contracture of facial muscles, chronic conjunctivitis).
The study was performed according to the principles of the Declaration of Helsinki. Informed consent of the parents was obtained for the research.
The authors declare that there is no conflict of interest.
References
AAP News. (2020, Feb 27). When can doxycycline be used in young children? By H. Cody Meissner M.D., FAAP. URL: https://www.aappublications.org/news/aapnewsmag/2020/02/27/idsnapshot022720. full.pdf.
Allen NM, Jungbluth H. (2016). Lyme neuroborreliosis: A potentially preventable cause of stroke. The Journal of Pediatrics. 170: 334-e1. https://doi.org/10.1016/j.jpeds.2015.11.077; PMid:26775545
CDC. (2021). Lyme Disease Charts and Figures: Historical Data. Lyme disease - Confirmed cases by month of disease onset, United States, 2008-2018. Centers for Disease Control and Prevention. URL: https://www.cdc.gov/lyme/stats/graphs.html.
Clark JR, Carlson RD, Sasaki CT et al. (1985). Facial paralysis in Lyme disease. Laryngoscope. 95: 1341. https://doi.org/10.1288/00005537-198511000-00009; PMid:4058212
Cohn KA, Thompson AD, Shah SS, Hines EM, Lyons TW et al. (2012). Validation of a clinical prediction rule to distinguish Lyme meningitis from aseptic meningitis. Pediatrics. 129(1): e46-e53. https://doi.org/10.1542/peds.2011-1215; PMid:22184651
D'Alessandro M, Loy A, Castagnola E. (2017). Management of Lyme disease in European children: a review for practical purpose. Current Infectious Disease Reports. 19(8): 27. https://doi.org/10.1007/s11908-017-0582-9; PMid:28681315
Guet-Revillet H, Levy C, Vallet C, Maghraoui-Slim V, Dommergues MA, Hentgen V et al. (2019). Lyme neuroborreliosis in children: Report of nine cases and a review of the literature. Archives de Pédiatrie. 26 (3): 133-137. https://doi.org/10.1016/j.arcped.2019.02.010; PMid:30885602
Knudtzen FC, Andersen NS, Jensen TG, Skarphédinsson S. (2017). Characteristics and Clinical Outcome of Lyme Neuroborreliosis in a High Endemic Area, 1995-2014: A Retrospective Cohort Study in Denmark. Clin Infect Dis. 65: 1489. https://doi.org/10.1093/cid/cix568; PMid:29048514
Margos G, Wilske B, Sing A et al. (2013). Borrelia bavariensis sp. nov. is widely distributed in Europe and Asia. Int J Syst Evol Microbiol. 63: 4284. https://doi.org/10.1099/ijs.0.052001-0; PMid:23838444
Medscape. (2019). Lyme disease treatment & management. URL: https://emedicine.medscape.com/article/330178-treatment. Updated Aug 01, 2019.
Ogrinc K, Lusa L, Lotrič-Furlan S et al. (2016). Course and Outcome of Early European Lyme Neuroborreliosis (Bannwarth Syndrome): Clinical and Laboratory Findings. Clin Infect Dis. 63: 346. https://doi.org/10.1093/cid/ciw299; PMid:27161773
Pritt BS, Mead PS, Johnson DK et al. (2016). Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study. Lancet Infect Dis. 16: 556. https://doi.org/10.1016/S1473-3099(15)00464-8; PMid:26856777
Södermark L, Sigurdsson V, Näs W, Wall P, Trollfors B. (2017). Neuroborreliosis in Swedish Children: A Population-based Study on Incidence and Clinical Characteristics. Pediatr. Infect. Dis. J. 36(11): 1052-1056. https://doi.org/10.1097/INF.0000000000001653; PMid:28654563
Stanek G, Strle F. (2018). Lyme borreliosis-from tick bite to diagnosis and treatment. FEMS Microbiol Rev. 42: 233. https://doi.org/10.1093/femsre/fux047; PMid:29893904
Zomer TP, Bruinsma R, van Samkar A et al. (2023). Lyme neuroborreliosis with antibodies in cerebrospinal fluid but not in serum. Eur J Neurol. 30: 741. https://doi.org/10.1111/ene.15631; PMid:36371644
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Modern pediatrics. Ukraine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
