Early Recovery of Grade IV Bell’s Palsy Following a Single Dose of IV Corticosteroids in a Rare Case of Zoster Sine Herpete Meningitis

Abstract

Bell’s palsy is a unilateral facial paralysis often linked to viral reactivation, and corticosteroids are part of guideline directed therapy. We present a rare case of a 37-year-old immunocompetent man who developed an acute left sided facial paralysis (House-Brackmann grade IV) secondary to herpes zoster. Notably, this case underscores the rare occurrence of Bell’s palsy following aseptic meningitis in the absence of cutaneous lesions, consistent with zoster sine herpete. Treatment incorporated emerging evidence of high-dose IV methylprednisolone showing superior recovery to grade I. Our patient saw complete resolution of facial paralysis symptoms in just over two weeks status post discharge. This case further highlights the potential benefit of early high-dose IV steroid therapy in moderately severe Bell’s palsy.