Management of Bell's palsy in a 2-month-old following COVID-19 infection: a case report and review of the literature.

BACKGROUND

Bell's palsy (idiopathic peripheral facial nerve paralysis) is uncommon in children and is particularly rare in infants younger than one year of age. Its occurrence following viral infections, including coronavirus disease 2019 (COVID-19), is exceedingly rare. We report a case of Bell's palsy in an infant following COVID-19 infection and provide a review of the relevant pediatric literature.

CASE PRESENTATION: We report the case of a 2-month-old female infant who developed left-sided facial weakness shortly after a COVID-19 infection. She had previously been healthy, except for a COVID-19-positive upper respiratory infection at the age of 4 weeks. Three weeks after her infection resolved, her parents noticed the sudden onset of left facial drooping, which progressed over the following three days. A diagnosis of peripheral facial nerve palsy following COVID-19 infection was proposed. Given the absence of clear treatment guidelines for infants, management options were carefully considered. The patient was ultimately started on oral prednisolone in addition to protective eye care. She demonstrated gradual clinical improvement during treatment, and at follow-up several weeks later, complete recovery of normal facial movement was observed.

CONCLUSIONS

This case highlights that Bell's palsy, although extremely rare in infancy, may occur following a viral infection such as COVID-19. A prompt and thorough evaluation is essential to exclude alternative causes of facial paralysis. Despite no clear guidelines or recommendations favoring corticosteroid treatment vs conservative management in this age category, a decision of pharmacologic treatment was taken. In this case, corticosteroid treatment was well tolerated, and no adverse events were observed. Further studies are needed to evaluate the correlation between COVID-19 infection and facial palsy in infants, and to further assess the efficacy and safety of oral prednisolone in this age group.