Non-Viral Etiology of Bell’s Palsy: A Case of Facial Nerve Palsy Secondary to Fungal Infection
Abstract
Bell’s Palsy is often attributed to activation of a dormant virus on the Facial Nerve, however, some evidence suggests that alternative etiologies may be underrecognized. This case describes an 80 year old male who developed acute left sided facial paralysis after experiencing months of persistent unilateral headaches which were treated with prolonged glucocorticoid therapy for presumed Giant Cell Arteritis. Initial imaging and laboratory evaluation were unrevealing, and he was diagnosed with Bell’s Palsy while remaining on the steroid regimen. Over the following weeks as he was followed by ETSU Family Medicine residents in both inpatient and outpatient settings, he continued experiencing headaches and progressive weakness until blood cultures, cerebrospinal fluid testing, and cytopathology from fine needle aspiration of a lung mass confirmed a diagnosis of disseminated Cryptococcus neoformans infection. His advanced age and extended steroid exposure likely facilitated fungal dissemination, with cryptococcal meningitis plausibly contributing to both his chronic headaches and Bell’s Palsy. Despite antifungal therapy, his neurologic deficits did not improve, and he eventually elected hospice care once deciding that he no longer wished to continue the antifungal regimen. This case highlights the importance of considering alternate etiologies of Bell’s Palsy, especially in patients with pre-existing symptoms in the physical location affected by the palsy, and in patients with prolonged immunosuppression where delayed diagnosis of the underlying cause may significantly alter outcomes.
Start Time
15-4-2026 1:30 PM
End Time
15-4-2026 4:30 PM
Room Number
Culp Ballroom 316
Poster Number
58
Presentation Type
Poster
Student Type
Graduate and Professional Degree Students, Residents, Fellows
Faculty Mentor
Heather Newman
Non-Viral Etiology of Bell’s Palsy: A Case of Facial Nerve Palsy Secondary to Fungal Infection
Culp Ballroom 316
Bell’s Palsy is often attributed to activation of a dormant virus on the Facial Nerve, however, some evidence suggests that alternative etiologies may be underrecognized. This case describes an 80 year old male who developed acute left sided facial paralysis after experiencing months of persistent unilateral headaches which were treated with prolonged glucocorticoid therapy for presumed Giant Cell Arteritis. Initial imaging and laboratory evaluation were unrevealing, and he was diagnosed with Bell’s Palsy while remaining on the steroid regimen. Over the following weeks as he was followed by ETSU Family Medicine residents in both inpatient and outpatient settings, he continued experiencing headaches and progressive weakness until blood cultures, cerebrospinal fluid testing, and cytopathology from fine needle aspiration of a lung mass confirmed a diagnosis of disseminated Cryptococcus neoformans infection. His advanced age and extended steroid exposure likely facilitated fungal dissemination, with cryptococcal meningitis plausibly contributing to both his chronic headaches and Bell’s Palsy. Despite antifungal therapy, his neurologic deficits did not improve, and he eventually elected hospice care once deciding that he no longer wished to continue the antifungal regimen. This case highlights the importance of considering alternate etiologies of Bell’s Palsy, especially in patients with pre-existing symptoms in the physical location affected by the palsy, and in patients with prolonged immunosuppression where delayed diagnosis of the underlying cause may significantly alter outcomes.
