Hansen’s disease predominantly affects the skin and peripheral nerves. Isolated cranial nerve involvement is uncommon, often resulting in diagnostic delay.
A 45-year-old man presented with isolated left lower motor neurone facial nerve palsy, initially diagnosed and treated as idiopathic Bell’s palsy. Four weeks later, he developed multiple erythematous, hypoesthetic papules and plaques over the face, trunk, and limbs, accompanied by fever. Examination revealed peripheral nerve thickening and sensory impairment over the skin lesions. A slit-skin smear demonstrated a bacteriological index of 5+, and a skin biopsy confirmed borderline lepromatous Hansen’s disease in a Type 1 reaction. Multibacillary multidrug therapy and systemic corticosteroids were initiated. Despite treatment, residual lagophthalmos persisted, necessitating partial tarsorrhaphy.
This case highlights isolated facial nerve palsy as a rare initial presentation of Hansen’s disease and underscores the importance of considering leprosy in the differential diagnosis of facial nerve palsy in endemic regions to prevent delayed diagnosis and irreversible nerve damage.
BT - Leprosy Review DA - 09/2026 DO - 10.47276/lr.97.3.2026032 IS - 3 LA - ENG M3 - Article N2 -Hansen’s disease predominantly affects the skin and peripheral nerves. Isolated cranial nerve involvement is uncommon, often resulting in diagnostic delay.
A 45-year-old man presented with isolated left lower motor neurone facial nerve palsy, initially diagnosed and treated as idiopathic Bell’s palsy. Four weeks later, he developed multiple erythematous, hypoesthetic papules and plaques over the face, trunk, and limbs, accompanied by fever. Examination revealed peripheral nerve thickening and sensory impairment over the skin lesions. A slit-skin smear demonstrated a bacteriological index of 5+, and a skin biopsy confirmed borderline lepromatous Hansen’s disease in a Type 1 reaction. Multibacillary multidrug therapy and systemic corticosteroids were initiated. Despite treatment, residual lagophthalmos persisted, necessitating partial tarsorrhaphy.
This case highlights isolated facial nerve palsy as a rare initial presentation of Hansen’s disease and underscores the importance of considering leprosy in the differential diagnosis of facial nerve palsy in endemic regions to prevent delayed diagnosis and irreversible nerve damage.
PB - Lepra PY - 2026 SP - 1 EP - 6 T2 - Leprosy Review TI - Isolated lower motor neuron facial nerve palsy as the initial presentation of borderline lepromatous Hansen’s disease: a diagnostic pitfall UR - https://leprosyreview.org/admin/public/api/lepra/website/getDownload/6a86932fafaac16c6e2f9923 VL - 97 SN - 2162-8807 ER -