Bilateral facial palsy following pulmonary infection--a possible variant of acute inflammatory polyradiculoneuropathy]

History and clinical findings: A 43-year old female presented with bilateral facial muscle weakness a month after onset of upper respiratory tract infection. Investigations: The neurologic examination on admission revealed bilateral facial palsy, no signs of muscular weakness, hyperreflexia and flexor plantar responses. Extensive laboratory analysis, radiological and neuroimaging assessment were unremarkable but analysis of cerebrospinal fluid revealed albumin-cytological dissociation. Sequentially, nerve conduction studies onfirmed demyelination of both facial nerves. A diagnosis of Guillain-Barre syndrome was made according to clinical findings, laboratory results and nerve study results. Treatment and course: IVIg therapy was initiated (2g/kg per 5 days) after no response to tapered intravenous corticosteroid therapy. Five days after the last IVIg dose the patient started to recover. Both eyes were treated with standard protective measures. Conclusion: Guillain-Barre syndrome is an acute autoimmune polyneuropathy characterized by a course of rapid ascending muscular weakness and mild sensory symptoms appearing approximately two-four weeks after an infection. The facial nerve is of all cranial nerves most often affected but it is rarely the prominent sign of GBS. As well, bilateral facial palsy has never been described as a sole manifestation of GBS, as of our notion.