Bell’s Palsy and Lyme Disease

My nephew Justin Cross

My nephew Justin was recently diagnosed with Lyme Disease. He’s at high risk because he works in the woods, and is diligent about checking himself thoroughly for ticks.

During his first month of cutting trees this season he found three ticks crawling across his skin and one in his mustache on the left side of his face. That one was attached, he says, but not engorged, so he was pretty certain it hadn’t been there for long. He also didn’t think any of them were deer ticks.

He started to feel achy in all his joints, even his wrists and elbows, but figured it was because he was working hard and was out of shape. He never got a bulls-eye rash, and it never occurred to him that he might have Lyme Disease.

A couple of weeks ago he lost his sense of taste. Everything — sweet and sour foods, even water — tasted salty.

“My taste buds went on Wednesday,” Justin told me, “and then on Friday I was at work and tried to whistle a tune, but couldn’t. I found a mirror and the whole left side of my face was just hanging!”

He got himself to Maine Medical Center’s Emergency Department, where he was quickly diagnosed with Bell’s Palsy. What’s that have to do with Lyme Disease? As it turns out, quite a bit.

What is Bell’s Palsy?
Bell’s Palsy is a temporary weakness or paralysis of the muscles on one side of the face. The muscles are controlled by the facial nerves.  The facial nerve begins in the brain stem and passes through the parotid gland where it divides into two main branches, one for each side of the face. The branches divide into 7000 smaller nerve fibers that control all our facial movements. A viral infection, most commonly one that causes cold sores, or a bacterial infection, such as Lyme Disease may cause Bell’s Palsy.  It’s not a given that if you have either cold sores or Lyme Disease you’ll get it, but in some people, the immune response to the infection causes the facial nerve — usually on only one side — to become inflamed and compressed, and the muscles are temporarily paralyzed.

That’s what happened to Justin.  He couldn’t raise his left eyebrow, smile, frown, grimace, open or close his eye, or even blink. Nothing. He also couldn’t produce tears or taste food. Here’s what he posted on Facebook: “Yeah. Lyme disease. Bell’s palsy from Lyme disease. Drooling on myself-at least I have a reason now.”

Yes, Justin has a sense of humor!

No one took a picture of him, but he says the one below, from Wikipedia, looks just like his did, only on the other side.

Person with Bell's on the right side Courtesy of Wikipedia

Connecting Justin’s Bell’s Palsy to Lyme Disease
As soon as the doctor in the emergency room found out he worked in the woods he ordered a blood test. It was positive for antibodies for Lyme Disease. A Western Blot test confirmed the diagnosis.

It turns out that facial paralysis is a stage two symptom of Lyme Disease that may show up from one to four months after infection. The achy joints Justin had in the month before his diagnosis are considered an early symptom. Only 85% of people with Lyme Disease get the bulls-eye rash.

Treating Bell’s Palsy and Lyme Disease
Justin was on Prednisone for four days for the Bell’s Palsy and is happy to report that he can smile and taste again. For the Lyme Disease, he’s still on an aggressive six-week course of Doxycycline, an antibiotic that he says is “God awful” because it upsets his stomach and makes his fair skin even more susceptible to sunburn.  “I forgot to do the backs of my hands recently because they are tanned from working outside and now they are swollen and burned!”

When he’s done, he’ll get tested again.

Let’s all cross our fingers!