Patient case strongly suggests link between COVID-19 vaccine and Bell’s palsy

The case of a patient who suffered two facial palsies – one after the first and one after the second dose of Pfizer-BioNTech COVID-19 vaccine – strongly suggests that Bell’s palsy (facial nerve palsy of unknown cause) is linked to Pfizer-BioNTech vaccine, doctors write in journal BMJ Case Reports.

They describe the first reported case in the medical literature of two separate unilateral facial nerve palsies, where muscles on one side of the face become weak or paralyzed, occurring shortly after each dose of a COVID-19 vaccine.

“The onset of episodes immediately after each vaccine dose strongly suggests that Bell’s palsy has been attributed to the Pfizer-BioNTech vaccine, although a cause and effect relationship cannot be established,” state the authors.

Single episodes of unilateral facial nerve palsy have been reported in initial clinical trials of the three major COVID-19 vaccines approved for use in the UK (Pfizer-BioNTech, Moderna and Oxford / Astra Zeneca), and there have been subsequent case reports.

In phase 3 trials, four cases of facial palsy of unknown cause (Bell’s palsy) were reported in volunteers who received Pfizer-BioNTech mRNA vaccine compared to none in those who received placebo vaccine, and three cases have been reported in volunteers who received the Moderna mRNA vaccine compared to a vaccine in the placebo group. Three cases of facial nerve palsy have also been reported in volunteers who received the Oxford / AstraZeneca vaccine during clinical trials, and there were three cases in volunteers who received the placebo vaccine.

This case report describes a 61-year-old Caucasian male with no history of facial nerve palsy who experienced an episode of Bell’s palsy on the right side of his face five hours after receiving his first dose of Pfizer-BioNTech vaccine, and a more severe episode of Bell’s palsy on the left side of his face two days after receiving the second dose.

The patient had a high BMI, high blood pressure, high cholesterol, and type 2 diabetes. Both doses of the vaccine were given to the left arm.

The patient attended the emergency department after the first episode, unable to properly close his left eye or move the left side of his forehead and was diagnosed with Bell’s palsy. Routine blood work and a head scan showed nothing to worry about and he was released on steroids, and the facial nerve palsy was completely resolved.

The patient received the second dose of Pfizer-BioNTech vaccine six weeks after the first and developed more severe left facial nerve palsy two days later. Symptoms included dribbling, difficulty swallowing, and an inability to completely close his left eye. He went to the emergency room, where he was again prescribed a course of steroids. He was also referred to the emergency room of the ENT (Ear, Nose and Throat) clinic, which continued on steroids and referred him to ophthalmology.

The authors report that his symptoms have improved greatly and the patient is almost back to normal. “The patient has been advised to discuss future mRNA vaccines with the general practitioner on a case-by-case basis, taking into account the risk versus the benefit of each vaccine,” they say.

Bell’s palsy is believed to be related to inflammation and swelling of the facial nerve due to the buildup of fluid (edema) caused by a virus. In 2004, the inactivated intranasal influenza vaccine was shown to significantly increase the risk of Bell’s palsy and was discontinued. An increased incidence of Bell’s palsy has also been observed after administration of other influenza and meningococcal vaccines, although a causal link has not been established.

Although most cases of Bell’s palsy resolve on their own over time, symptoms can lead to significant temporary disability, affecting facial expression and the ability to eat and drink. Risk factors include diabetes, obesity, hypertension, pregnancy, preeclampsia, and upper respiratory tract disease.