To investigate the clinical characteristics of peripheral facial paralysis in patients with human immunodeficiency virus (HIV) infection.

The clinical data of HIV-infected patients with a diagnosis of peripheral facial palsy attending to Beijing Ditan Hospital, Capital Medical University from January 2017 to December 2019 were collected, and related literature were reviewed.

Total of four male patients were enrolled, aged from 28 to 49 years old, most of them had high risk factors of HIV infection, such as drug abuse, male homosexual behavior and high-risk sexual behavior. HIV antibody in screening test and western blot were all positive. CD4⁺ T cells of case 1 and case 4 were both < 200 cells/μl. None of them received highly active antiretroviral therapy (HAART) before. All the cases were unilateral peripheral facial paralysis. Two cases were left peripheral facial paralysis alone. One case was right peripheral facial paralysis with vertigo, ear pain, herpes around the ear. And one case was left peripheral facial paralysis with hearing loss of both ears. Syphilis infection was found in three patients and Epstein-Barr virus infection was found in four patients. Case two had otitis media suppurativa and otitis externa herpetica; case three had acute lymphoblastic leukemia and case four had lymphoma leukemia both suggested by bone bymarrow puncture. Case one was treated with some neurotrophic drugs (VitB1 and Cobamamide). Neurotrophic drugs such as Cobamamide and acyclovir were the mainstay treatment for case two. Because of status epilepticus, case three was given diazepam and mannitol. Case four was treated by HAART with lamivudine, efavirenz. He also received neurotrophic drugs and rituximab. Case one and case two had a good recovery, case three and case four died.

For patients with peripheral facial paralysis had high-risk behaviors, clinicians should consider HIV infection, early diagnosis and treatment are very important.