A Rare Manifestation of Post-Treatment Neuropathy: Facial Diplegia Following A Rare Case of Bilateral Facial Paralysis Following Treatment for Leptospirosis

Abstract

Introduction:
Leptospirosis, a zoonotic bacterial infection, can occasionally lead to rare post-infectious complications.[1] While the acute phase often involves systemic manifestations, delayed neurological sequelae such as facial diplegia are uncommon and underreported. This case highlights bilateral lower motor neuron facial palsy as a potential post-infectious complication [2] Case presentation: A 58-year-old man was treated for leptospirosis after presenting with fever, headache, and muscle aches following exposure to floodwaters. Diagnosis was confirmed by positive Leptospira serology, elevated liver enzymes (ALT 140 U/L, AST 122 U/L), and mild renal impairment (serum creatinine 1.6 mg/dL). He was successfully treated with intravenous penicillin and oral doxycycline, with full resolution of acute symptoms. Two weeks post-treatment, the patient developed bilateral facial weakness, with difficulty raising his eyebrows, asymmetry in smiling, and incomplete eyelid closure. Neurological examination confirmed bilateral lower motor neuron facial palsy, without limb weakness or other neurological deficits. MRI of the brain and EMG confirmed the diagnosis, with no evidence of stroke, mass lesions, or ongoing infection. Conclusion:
This case underscores the importance of recognizing delayed neurological complications following leptospirosis. The likely etiology in this patient was immune-mediated inflammation triggered by the infection. Treatment with corticosteroids and physical therapy led to significant improvement. Clinicians should maintain vigilance for post-infectious sequelae in leptospirosis patients, as timely intervention can improve outcomes