Bilateral facial nerve paralysis and acute HIV-1 infection

Abstract

Bilateral facial nerve paralysis is a rarely reported but recognized complication that follows acute HIV-1 infection. HIV seroconversion illness or acute HIV infection is present in approximately 40-90% of primary HIV infected patients. Patients with acute HIV-1 infection typically present with fever, rash myalgias, arthralgias, and lymphadenopathy. Most of these appear in two to four weeks following the initial infection. We report a patient experiencing HIV-1 seroconversion as described who presents with bilateral facial nerve paralysis. Related literature of this subject is also reviewed. We report a 33-year-old Hispanic male, with no significant past medical history, who presented with bilateral facial nerve paralysis in the setting of a viral-like prodrome of fevers, malaise, muscle aches and sore throat. After a full workup, the patient was subsequently diagnosed with an HIV-1 infection. His facial paralysis resolved over a course of five months. Unilateral and bilateral facial paralysis occur at over 100-fold greater frequency in HIV-infected patients. However, even among patients with an acute HIV infection, bilateral facial paralysis is exceedingly rare, as only 12 cases have been reported worldwide over the last 20 years. Because the onset of facial paralysis closely follows HIV-1 seroconversion, its presence can facilitate early diagnosis and treatment of those newly infected with HIV-1. In a patient who is at risk and presents with a new facial paralysis, HIV infection should be considered as a possible underlying etiology.