Bilateral facial nerve palsy in an exposure-endemic region should raise suspicion for which infection?

• A. Acyclovir-resistant herpes
• B. Lyme disease
• C. Syphilis
• D. Varicella Zoster

Answer: (B)

Bilateral facial nerve palsy in a person from an area where Lyme disease is common points to neuroborreliosis from Borrelia burgdorferi. In Lyme disease, facial nerve involvement is a classic neurologic manifestation of the early disseminated stage, and it often presents bilaterally—unlike Bell palsy, which is typically unilateral. Because the presentation fits the pattern seen with Lyme in endemic regions, it should raise suspicion for Lyme disease and prompt appropriate serologic testing (screening with ELISA, confirmed by Western blot) and treatment if confirmed. Other causes like herpes zoster or syphilis can cause facial palsy but are less likely to present bilaterally in this epidemiologic context, and zoster typically has vesicular findings or耳 involvement.