Bilateral lower motor neuron type facial nerve palsy as the first presentation of seroconversion of HIV: A case report

Unilateral involvement is the commonest presentation of facial nerve palsy. Bilateral lower motor neuron (LMN) facial nerve palsy is uncommon, indicating an underlying systemic pathology. Guillain-Barré syndrome and its variant Miller-Fisher syndrome is the commonest aetiology with an underlying demyelinating pathology. Sarcoidosis, leprosy, infectious mononucleosis, Lyme disease, and tuberculous meningitis are associated with bilateral facial nerve palsy. Human immunodeficiency virus (HIV) can cause facial nerve palsy at any stage of the disease, but rarely during the phase of acute seroconversion. We report a 41-year-old female who presented with fever, arthralgia, and myalgia, followed by the development of bilateral LMN facial nerve palsy during the fifth day of her illness, associated with non-tender cervical lymphadenopathy, generalised maculo-papular rash without any organomegaly. Neurological examination was unremarkable except for bilateral lower motor neuron facial nerve weakness. HIV-1 antibodies were detected using an enzyme-linked immunosorbent assay (ELISA), and a CD4 count confirmed the diagnosis. This case highlights the importance of considering HIV as a cause for bilateral facial nerve palsy in patients presenting with an acute febrile illness.