Facial diplegia with paresthesias (FDP) is a rare variant of Guillain-Barré syndrome (GBS) that may be associated with anti-ganglioside antibodies.

A 26-year-old male with a history of SARS-CoV-2 infection in July 2020 presented to his physician in September with a sore throat. He was diagnosed with streptococcal pharyngitis and completed a course of amoxicillin. He returned the following week with right-sided facial paralysis and was prescribed prednisone and acyclovir for a presumed Bell’s palsy. Despite this, his symptoms progressed over the next week to include bilateral facial paralysis, paresthesias of the fingers and toes, and mild weakness of his right hand and leg. Neurologic exam was notable for facial diplegia, sensory deficits to pinprick in a stocking-glove distribution, and mild weakness of the right hand and lower extremity. MRI Brain demonstrated thin relatively symmetric enhancement of the bilateral facial nerves. Lumbar puncture revealed elevated protein with normal cell count, consistent with cytoalbuminologic dissociation, and he was started on intravenous immunoglobulin given concern for a GBS variant. Nerve conduction studies of the right upper and lower extremities showed no abnormalities. However, nerve conduction studies of the right facial nerve demonstrated a proximal demyelinating process. His ganglioside antibody panel was positive for anti-GD1a IgG/IgM antibodies. The patient completed his course of intravenous immunoglobulin and was subsequently discharged, showing near-resolution of his right-sided extremity weakness and improving facial diplegia.

This case illustrates the clinical features of Facial Diplegia with Paresthesias, a rare variant of Guillain-Barré syndrome, and suggests an association with anti-GD1a IgG/IgM antibodies. Most reports of FDP are associated with anti-GM2 antibodies. Additionally, this case may represent an interesting neurologic sequela of SARS-CoV-2 infection, possibly due to post-infectious stimulation of an immune response in a manner similar to other GBS-associated pathogens.