EARLY TREATMENT WITH PREDNISOLONE AND ACYCLOVIR IN SARS-COV-2 COMPLICATED BELL'S PALSY: A CASE REPORT

ABSTRACT

Bell's palsy is an idiopathic, unilateral, acute weakness of the face in a pattern consistent with peripheral facial nerve dysfunction and may be partial or complete, occurring with equal frequency on either side of the face. The incidence is about 20 in 100,000 people a year, with about 1 in 60-lifetime risks. Bell's palsy has a peak incidence between the ages of 15 and 40 years. Viral infections are commonly associated with facial nerve pathology, which leads to peripheral facial paralysis. A potential cause of peripheral facial paralysis might be COVID-19 and neurological symptoms could be the first and only manifestation of the disease. Possible mechanisms related to nerve damage in idiopathic facial nerve paralysis include ischemia of vasa nervorum and demyelination induced by an inflammatory process. Direct viral damage or an autoimmune reaction toward the nerve-producing inflammation would be alternative or contributing mechanisms to dysfunction. Acyclovir (aciclovir) is a nucleoside analogue antiviral drug active against some of the herpes virus groups of DNA viruses and RNA viruses. The mechanism of prednisolone may involve modulation of the immune response to the causative agent or direct reduction of edema around the facial nerve within the facial canal. Prednisolone and acyclovir are commonly prescribed separately and in combination, although evidence of their effectiveness is weak. We report a case diagnosed with COVID-19 after presenting with isolated peripheral facial palsy.