Granulomatosis With Polyangiitis Presenting as Acute Bilateral Facial Nerve Paralysis

In the existing literature, there are 14 cases of bilateral facial palsy as a presentation of GPA, however, this presentation is the first in the existing literature without evidence of systemic involvement. This highlights that the absence of other systemic involvement and negative initial autoimmune workup does not exclude GPA as the etiology of facial palsy. Continued re-evaluation of systemic involvement and biopsies of middle ear contents is crucial in diagnosis.