A case of suspected sarcoidosis with bilateral simultaneous facial nerve paralysis

Abstract

Bilateral facial nerve palsy is a rare condition accounting for approximately 5% of all facial palsies. Various systemic diseases may cause bilateral facial nerve palsy, one of which is sarcoidosis. Sarcoidosis is a systemic granulomatous disease that commonly affects the lungs, heart, and eyes, and may also involve the nervous system. The facial nerve is the most frequently affected cranial nerve in patients with neurosarcoidosis, with 40–60% of cases manifesting with facial paralysis.

A 50-year-old man presented with right-sided facial weakness and consulted another hospital the next day. Bell’s palsy was diagnosed and treated with prednisolone. However, a week later, the facial palsy extended to the left side of the face. He was admitted to our hospital and was diagnosed with bilateral facial nerve paralysis. We investigated the cause of bilateral facial nerve palsy but were unable to reach a conclusive diagnosis. Sarcoidosis was believed to be the cause of bilateral facial palsy, given the disease’s progression and the presence of bilateral hilar lymphadenopathy. He was given steroids, and his palsy improved five months later. This study highlights that the involvement of systemic disease should be considered in patients with bilateral facial nerve palsy.