Acute Flaccid Paralysis: Intravenous Immunoglobulin is Not the Drug of Choice Always!

Bilateral Facial Nerve Palsy in a Young Woman From West Bengal: Do Not Forget Lyme Neuroborreliosis

Borrelia burgdorferi can affect the nervous system in various ways, which can generate significant confusion and dilemma regarding diagnosis. From India, a country until recently known to be a nonendemic zone for Lyme disease, several cases and one study of Lyme neuroborreliosis have been published. The aim of this study was to describe a young woman with bilateral facial nerve palsy as the presenting manifestation of Lyme neuroborreliosis. We herein report a case of a lactating woman with acute onset progressive ascending flaccid tetraparesis that was preceded by a misdiagnosed bilateral facial nerve palsy. She was finally diagnosed to be a case of acute Lyme neuroborreliosis, which responded favorably to intravenous and orally administered antibiotics. The possibility of Lyme neuroborreliosis should be considered more often from now on because in the last year four cases with the kindred clinical syndrome have been described from a so-called "nonendemic zone."