Alla faccia di Bell: un caso clinico di paralisi bilaterale in una paziente di sei anni

Bilateral facial palsy (BFP) is an uncommon condition characterised by the involvement of the opposite side within 30 days from the onset in the first side. If paralysis occurs simultaneously on both sides, it is termed simultaneous BFP. Otherwise, it is referred to as sequential BFP. The most common cause is Borrelia Burgdorferi infection. This case report describes a case of sequential BFP in a 6-year-old child who initially presented with right facial palsy and loss of the right stapedial reflex. As unilateral facial palsy (Bell's Palsy) was suspected, the patient was treated with prednisone. After ten days, a nearly complete remission of symptoms was observed. On day 23 from the onset of right facial palsy, the patient developed identical symptoms in the left side. Borrelia burgdorferi antibodies were detected by ELISA that showed positive IgM and IgG results. Cranial and spinal MRI revealed multiple areas of contrast enhancement along the facial nerve, consistent with post-infectious neuritis. Consequently, a 20-day course of amoxicillin was initiated, combined with prednisone. A month later, the patient fully recovered with a complete seroconversion. This is a noteworthy case because it occurred in an Italian region typically not endemic for tick bites.