Peripheral facial paralysis as presenting symptom of COVID-1
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A 35-year-old woman, primigravida, 39-week gestation, presented with a 2-day onset of progressive left-side labial commissure deviation. A physical examination, she had involuntary drooling, left-side labial commissure deviation, and ipsilateral lagophthalmos. She had no other symptoms, including fever, dyspnoea, odynophagia, ear pain, dermatomal pain, face swelling, skin rash, cough, myalgias, anosmia, ageusia, or diplopia. No recent history of respiratory infection or SARS-CoV-2 epidemiologic context was reported. On neurological examination, she exhibited left peripheral facial palsy. The remaining exam revealed no abnormalities, including signs of other cranial neuropathies or limb weakness. No vesicles in the external ear were observed and otoscopy was unremarkable.

Laboratory results on admission were significant for mild leucocytosis, with relative lymphopenia and relative neutrophilia as well as increased C-reactive protein level. Platelet count and liver enzymes were within normal values. Probable Bell’s palsy was assumed. Corticosteroid therapy (10-day tapering prednisolone course, starting at 60 mg/day) was initiated in order to optimize functional recovery. Eye hydration measures were also undertaken. As she presented with regular uterine contractions, she was admitted to the labor ward. According to the universal screening protocol established in the department, a nasal swab for the SARS-CoV-2 PCR test was performed. She tested positive for SARS-CoV-2; consequently, proper containment measures were implemented.

She had normal labor progression, without intrapartum fever, and delivered vaginally a 2870 g newborn with a 5-minute Apgar Score of 10. After careful counseling, the woman decided not to be separated from the newborn and started breastfeeding. During the hospital stay, she was counseled to take all precautions in order to minimize possible contamination of the newborn. Newborn SARS-CoV-2 testing at birth and at 48 hours of life was negative. She started facial physiotherapy exercises, and 15 days after birth neurologic deficits slightly improved. She remained apyretic and without any respiratory symptoms.

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Dr. R●●●●h b●●u General Medicine
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Aug 12, 2020Like