Improvement of Bell’s palsy associated with resolution of acute hepatitis B infection

A 61-year-old man was admitted to the emergency department with facial asymmetry. He had no history of systemic disease or drug usage. Neurologic examination showed no forehead motion, incomplete eye closure and slight mouth movement on the left side. The House–Brackmann score was grade V. General physical examination was normal. Liver tests were abnormal: alanine aminotransferase (ALT) was 888 IU/L, aspartate aminotransferase (AST) 558 IU/L, total bilirubin 1.47 mg/dL, and direct bilirubin 0.59 mg/dL. Because of elevated liver enzymes more than ten times the upper limit of the normal range, serologic markers for viral hepatitis were ordered. The hepatitis B surface antigen (HBs-Ag), hepatitis B e-antigen (HBe-Ag) and hepatitis B core antibody IgM [HBc-Ab (IgM)] were positive, hepatitis B surface antibody (HBs-Ab) negative, hepatitis B virus (HBV)-DNA was 1,748,540 copies/mL. The patient was diagnosed with acute hepatitis B. Because of acute hepatitis B infection, he was followed up without steroid therapy by both gastroenterology and otolaryngology departments. Four months later, control laboratory analysis revealed that ALT was 36 IU/L, AST, 32 IU/L; anti-HBs, positive; Hbs-Ag and HBV-DNA, negative. House–Brackmann scale improved to grade 0. …