Response to comment on: Facial nerve palsy after COVID-19 vaccination – A rare association or coincidence

Dear Editor,

The case of unilateral lower-motor-neuron type facial nerve palsy post COVID-19 vaccination[1] was published to highlight this rare possible adverse event. The authors acknowledge the comments raised[2] and attempt to address the same point-by-point.

First, the patient[1] had isolated unilateral lower-motor-neuron type (peripheral) facial nerve palsy with no systemic focal sensory or motor neurological deficit. There was no extraocular muscle palsy nor any other cranial nerve involvement. A detailed neurological and systemic examination revealed normal examination. In view of absence of any other neurological deficit, MRI-Brain was denied by the patient. The patient did present with temporal ectropion and chemosis along with lagophthalmos, but there was a rapid response to therapy. The clinical features of ectropion and congestion are not universal in facial nerve palsy and have been reported in 8.8% of 31 patients reported in a case series.[3]

Second, a COVID-19 Polymerase chain reaction test was performed and was reported negative at presentation. The patient was a COVID-19 recovered patient in May 2020 and had received both doses of COVID-19 vaccine in April and May 2021. He presented with the above-mentioned complaints 3 days after the second dose of vaccine.

Third, it is a routine practice to evaluate a patient for underlying diabetes before starting systemic steroids.[4] Our patient did not have underlying diabetes or hypertension. The routine investigations including HbA1c, fasting sugar, vitals including blood pressure and intraocular pressure were within normal range and documented before starting oral steroids. The patient was clinically followed up closely after starting oral steroids and had a favorable response within the first week, with a complete clinical recovery in 2 weeks. Intermittent fasting sugar levels were monitored by the patient as he was educated for a possible derangement during the course of steroids. Acyclovir has not been routinely found to be beneficial in facial nerve palsy.[5] In view of rapid clinical recovery, no investigation for other viral etiologies was carried out, and acyclovir was not required in our patient.

Lastly, the authors do agree that the facial nerve palsy could have been a mere coincidence which the authors have already acknowledged in their article.[1] Most Adverse Events Following Immunization (AEFI) following COVID-19 vaccination in India are mild and self-resolving including fever, headache, injection site pain, and rash.[6] The case was reported to Immunization program authorities and AEFI Committee for information and documentation where again the same diagnosis of unilateral peripheral isolated facial nerve palsy temporally associated with 2^nd dose of COVID-19 vaccination was accepted and recorded.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.