Scenario:
Shortly after returning from a family holiday to France, Ella experienced early signs of facial palsy and was initially incorrectly diagnosed with a suspected unspecified allergic reaction by a doctor in A&E. As the facial palsy became more pronounced the next morning, Ella was again taken to A&E. The doctor there was aware that Lyme disease can cause facial palsy so tested Ella and a few days later results confirmed the diagnosis. Ella quickly received appropriate antibiotics and all symptoms resolved over the following weeks. This shows how important it is to consider Lyme disease in cases of facial palsy, and the value of early antibiotics to effectively treat the infection.
Ella’s parents noticed something odd about their daughter’s eye shortly after returning from their holiday. It looked like she was squinting, and by the next day it had become really noticeable. She was holding her eye strangely and they were concerned enough to seek medical advice.
After calling 111 they visited A&E, where Ella was given Piriton for a suspected unspecified allergic reaction. After that, the eye seemed to improve, so they felt somewhat reassured.
However the next morning it was clear that Ella was squinting and one side of her face wasn’t moving at all. Her eye looked more open than usual because the muscles around it weren’t working.
The family attended Winchester A&E where Ella was diagnosed her with Bell’s palsy. The doctor there knew that facial palsy can be linked to Lyme disease so tested for the illness even in the absence of a known tick bite or a erythema migrans (EM) rash. Ella was given antibiotics straight away while waiting for blood test results to limit the spread of infection. She was also given a course of steroids to help with nerve inflammation.
A few days later, test results showed Ella was positive for Lyme disease. At this point she had no other symptoms – no fever, no rash, no joint pain – just the paralysis on one side of her face. Ella was also referred for an eye appointment as her eyelid wasn’t closing properly.
Three weeks later Ella’s symptoms had completely recovered following her course of antibiotics. A quick diagnosis and early treatment had resulted in an excellent outcome.
Learning points:
- Early symptoms of facial paralysis were unclear and were not linked to Lyme disease by the A&E doctor.
- Fortunately Ella returned to A&E quickly as the facial paralysis became more obvious. The doctor was luckily aware of the link with Lyme disease, particularly in children, even without a known tick bite or EM rash.
- Appropriate antibiotic treatment was started quickly without waiting for Lyme disease test results. This is important as Lyme disease tests may not be accurate in early-stage disease. There are also other limitations with tests for Lyme disease so they cannot be used to rule out a Lyme infection where there is clinical suspicion of the illness.
- Early diagnosis and antibiotics are important to treat the illness and prevent later-stage disease.
(C) Lyme Borreliosis Foundation
