Progressive Bilateral Weakness Followed by Unilateral Facial Palsy in Guillain-Barré Syndrome Temporally Associated With Multiple Vaccinations

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy in which facial weakness may occur as a cranial neuropathy.Unilateral facial palsy may also prompt a diagnosis of idiopathic Bell's palsy, creating a risk of diagnostic anchoring when broader neurologic symptoms are already present.We report a 32-year-old man with childhood epilepsy who described progressive bilateral upper and lower extremity weakness with paresthesias for approximately two weeks, followed by left facial paralysis about one week later.He also reported co-administration of hepatitis B, influenza, and tetanus vaccines approximately three weeks before presentation; the vaccine products and dates were not independently verified.An outside hospital treated the facial paralysis as presumed Bell's palsy with acyclovir, although the available records do not establish the facial examination pattern, acyclovir regimen, whether corticosteroids were prescribed there, or whether the preceding bilateral limb symptoms were recognized.An outpatient electrodiagnostic study was reportedly interpreted as concerning for GBS, but the complete nerve conduction/electromyography report was unavailable.Cerebrospinal fluid (CSF) showed white blood cells of 5/mm³, glucose of 59 mg/dL, and protein of 190 mg/dL, supporting albuminocytologic dissociation; a paired serum glucose was unavailable.The patient completed a five-day course of intravenous immunoglobulin (IVIG), and prednisone plus valacyclovir was also documented for the facial palsy, although their exact dose, route, and duration were not recoverable.The source record documented short-term neurologic improvement before discharge.This case emphasizes that unilateral facial palsy should not distract from pre-existing bilateral weakness and paresthesias and that facial weakness in this setting may represent GBS-related cranial neuropathy rather than a separate confirmed Bell's palsy.The temporal association with vaccination does not establish causality.