Unilateral Isolated Peripheral Facial Paralysis as a Presenting Finding of COVID-19 in Two Previously Vaccinated Patients Case Reports

Abstract

To report on two patients with COVID-19 after presenting with unilateral isolated peripheral facial palsy; both had previously double doses of vaccination against coronavirus-2 (SARS-CoV-2) infection. Two female patients presented with symptoms of progressive unilateral labial deviation, lagophthalmos, and drooling. Both patients had double doses of prophylactic COVID-19 vaccine, Pfizer-BioNTech 6 months, and Sinovac/CoronaVac 12 months previously. The diagnosis of isolated unilateral peripheral facial paralysis was made, and short-term daily oral methylprednisolone (1mg/kg) was started for two weeks. A week later, both patients complained of various symptoms and signs of COVID-19. Acute facial nerve involvement is frequently associated with viral infections, and isolated peripheral facial paralysis may be the first and only presenting finding of COVID-19 infection even if the patients are vaccinated against the COVID-19 pandemic.