To the Editor.—We read with great interest Bomholt's1 article on facial palsy in lymphocytic meningoradiculitis in the November Archives. However, we consider it important to point out that a tick-borne spirochetal infection should be carefully looked for and ruled out in patients suffering from the signs and symptoms described in the article.
It has recently been shown that Lyme disease in the United States2 as well as erythema chronicum migrans Afzelius3 and related disorders, such as Bannwarth's syndrome4 and acrodermatitis chronica atrophicans5 in Europe, are caused by tick-borne spirochetes. Cranial nerve paralysis and facial palsy in particular may occur as one clinical symptom in the spectrum of different manifestations seen in both Lyme disease and erythema chronicum migrans Afzelius—related disorders.
In a prospective study at our hospital of patients with a preliminary diagnosis of Bells's palsy, analyses of sera from these patients revealed, in
ÅSBRINK E, OLSSON I, HOVMARK A, CARLSSON B. Facial Palsy. Arch Otolaryngol. 1985;111(5):349. doi:10.1001/archotol.1985.00800070101021
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