Bell’s palsy mimicker in Infant: Tuberculoma presenting as peripheral facial nerve palsy

Bell’s palsy is an acute onset lower motor neuron (LMN)/peripheral facial nerve palsy that is not associated with any other cranial nerve neuropathies or brain stem dysfunction. Many neurological disorders can present as acute onset peripheral facial nerve palsy. A 3½ month-old baby developed an acute onset of deviation of the mouth toward the left side and inability to close the right eye. At 5 months of age, the child had persistent facial weakness and a new onset of cough form 7 days. Neurological examination revealed right LMN facial palsy (Grade 4 on House–Brackmann scale) and subtle sixth nerve palsy. Magnetic resonance imaging of the brain and chest was done and suggestive of multiple tuberculomas and miliary tuberculosis, respectively. The patient improved on antitubercular therapy and steroids. This case report emphasized on broad differential diagnosis, a four-step approach to facial nerve palsy and etiology specific intervention to improve the outcome of facial palsy.