Abstract Details

Title Bilateral Facial Weakness in a Newly Diagnosed HIV Patient: A Rare Presentation

Topic Infectious Disease

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 3-009

Objective NA

Background Bilateral facial nerve palsy is an uncommon neurological presentation, accounting for less than 2% of facial palsy cases. Reported causes include Guillain-Barré syndrome, Lyme disease, sarcoidosis, and infectious etiologies. Of infectious etiologies, HIV infection has been documented as a rare precipitant.

Design/Methods Case Presentation: A 34-year-old man presented with one month of progressive bilateral facial weakness and blurry vision, more pronounced on the left. Neurological examination demonstrated upper and lower motor involvement of cranial nerve VII bilaterally, impairing eye closure bilaterally and muscles of facial expression. He did not have any other neurological deficits on the exam. Laboratory studies showed an HIV RNA viral load of 46,400 copies/mL and a CD4 count of 80 cells/μL, confirming a new diagnosis of AIDS. In addition, he was later found to have positive histoplasma with complement fixation titer of 1:8. CSF analyses for HIV, HTLV, Lyme, TB, West Nile Virus, Listeria, Coccidioides, and JC virus were negative. The patient was started on antiretroviral therapy, a ten-day course of valacyclovir, and a seven-day course of corticosteroids, with no significant improvement in facial motor function during hospitalization.

Results NA

Conclusions This case highlights HIV infection as a potential underlying cause of bilateral facial nerve palsy. Clinicians should maintain a high index of suspicion for HIV when evaluating atypical or bilateral cranial neuropathies, as early recognition and treatment can improve outcomes and prevent opportunistic complications.

Authors/Disclosures
Betelhem Zewdie PRESENTER	Ms. Zewdie has nothing to disclose.
Sebastian Garza Hernandez, MD (University of Missouri, Kansas City School of Medicine)	Dr. Garza Hernandez has nothing to disclose.
Sari F. Yordi, MD (University of Missouri, Kansas City)	Dr. Yordi has nothing to disclose.
William C. Murphy, MD (University Health-Truman Medical Center)	Dr. Murphy has nothing to disclose.

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