Bell’s palsy following post COVID-19 infection myocarditis in pregnancy: the first case report

Abstract

Background and aims: Lower motor neurone facial nerve palsies are a rare complication of SARS-CoV-2 infection. Bell's palsy following COVID myocarditis has been reported previously but whether they are associated is not known. We report the first case of the above combination in pregnancy. Methods: A 27-year-old Sri Lankan in her 2nd pregnancy complicated with pregnancy induced hypertension since POA of 26weeks presented at 30weeks with fever, productive cough and exertional dyspnoea for 4days. She was tachypnoeic (RR-40min) and tachycardic (PR-120min). There was a left-sided mild pleural effusion (later confirmed by ultrasound) with clear lung fields (SpO2-97%). The ECG had widespread T inversions and ST-depressions, 2D-Echo had global hypokinesia with a thin rim of pericardial fluid. Serum troponins were marginally elevated (0.4ng/ml). She had a neutrophil leucocytosis with elevated ESR (120mm/h), CRP (291mg/l) and D-dimers (1249ng/ml). Deep vein thrombosis and pulmonary embolism were excluded by imaging. Blood and urine cultures were negative. The SARS-CoV-2 PCR was weakly positive with a strong positivity for COVID antibodies. Serology for enterovirus, rickettsia, Legionella and Mycoplasma were negative. She had an uneventful recovery after a hospital stay of 2weeks managed symptomatically and with prophylactic antibiotics.