Facial nerve paralysis in Lyme borreliosis in a child (clinical case)

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.