ODP167 Bell's Palsy As A Possible Post-Covid-19 Complication In Patient With Type 2 Diabetes

Abstract

Abstract Background Diabetes is associated with increased risk of post COVID-19 infection complications which has been postulated to be due to uncontrolled carbohydrate, fat metabolism and raised insulin resistance. Bell's palsy (BP) is an idiopathic unilateral facial paralysis that constitutes the most common cause immune response after a viral infection. Clinical Case A 48- years-old male with type 2 diabetes (BMI-35,3 kg/m 2,HbA1C- 7.6%). He was on regular treatment with metformin(daily doses (DD)– 1500 mg)for the last five years. Before 4 months for hospitalization in the patient was positive nasopharyngeal polymerase chain reaction (PCR) test for SARS-CoV-2 and he didn't develop clinical symptoms of COVID-19, that confirmed asymptomatic coronavirus disease. The male had no history of trauma or systemic infection, and presented no skin eruptions compatible with herpes zoster infection. There were asymmetric wrinkling of the forehead inability to raise the right eyebrow, failure to close the right eyelid, and right deviation of the angle of the mouth (right-sided droop), suggesting right seventh cranial nerve palsy of lower motor neuron type. Signs of meningeal irritations were absent. The neurologist confirmed the diagnosis of right unilateral BP. On hospital stay the patient was treated: metformin (DD – 2000 mg), dapagliflozin (DD – 10 mg), and subcutaneous insulin degludec (DD – 22 units); oral prednisolone at 40 mg/day for one week, which was subsequently tapered to 35 mg/day for 7 days and 30 mg/day for the next 7 days, with a total of 2 months of treatment and assigned to 15 sessions of acupuncture treatments during 10 minutes 5 times/week. The result discussion of clinical studies that diabetes was not a poor prognostic indicator if treated with corticosteroids in diabetic BP patients. Facial palsy started improving after 15 days of admission, and throat swab PCR for SARS-CoV-2 came negative during hospitalization. He was discharged on the 23th day of admission. After3 months, the treating team contacted the patient by phone and realized that he was in good condition, and his facial weakness had improved significantly. However, there are still some residual weaknesses. The sixth months therapy resulted in patient's recovery functions of right seventh cranial nerve and compensation of type 2 diabetes was achieved (HbA1C-7. 0%). Conclusion We assume that our patient got BP secondary to post-COVID-19 complication. These findings support the use of corticosteroids and sessions of acupuncture when necessary for treatment of post-COVID-19 neurological complications in subjects with diabetes. We believe that further research should be conducted to clarify the pathogenic association between COVID-19 and BP in patients with type 2 diabetes and improve algorithm of treatment. Presentation: No date and time listed