case_images: PMC10620857_01
case_images: Graphical abstract
case_images: EXCLI-22-992-g-001.jpg
case_images: PMC10620857_01_EXCLI-22-992-g-001.jpg
case_images: F1
case_images: The right-hand side of the face showed a semi-unilateral palsy presenting as a lower motor neuron malfunction of all branches of the facial nerve (temporal, zygomatic, buccal and mandibular branches; Figure 2(Fig. 2)). The early facial weakness of our patient reflected the nerve branches at both the upper and lower parts of the face (see Figures 2(Fig. 2), 3(Fig. 3) and 4(Fig. 4)).
case_images: Patient showed unilateral right facial palsy seemingly affecting all branches of cranial nerve VII. This was his condition 5 months post the mRNA vaccination.
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case_images: PMC10620857_01_EXCLI-22-992-g-002.jpg
case_images: F2
case_images: Another two months later the patient was showing progressive wasting and loss of weight (12 kg) with progressing facial palsy symptoms (Figure 3(Fig. 3)). The early facial weakness of our patient reflected the nerve branches at both the upper and lower parts of the face (see Figures 2(Fig. 2), 3(Fig. 3) and 4(Fig. 4)). Our patient had a right forehead diminution of wrinkling (see Figure 3(Fig. 3)), and complete paralysis of muscles controlled by ophthalmic facial nerve branches (see Figure 4(Fig. 4)) (Marfeo, 2010).
case_images: Progressive inability to open the right eye and right side of mouth. This was his condition 7 months post the mRNA vaccination.
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case_images: F3
case_images: Four months after that - now 8 months post-mRNA injection - the patient showed increased temporal pain, deafness in the right ear, progressive wasting, inability to open the right eye, inability to open the right side of his mouth, vertigo, and limb weakness (Figure 4(Fig. 4)). Our patient had a right forehead diminution of wrinkling (see Figure 3(Fig. 3)), and complete paralysis of muscles controlled by ophthalmic facial nerve branches (see Figure 4(Fig. 4)) (Marfeo, 2010). The facial palsy of our patient reflected all (temporal, zygomatic, buccal mandibular and platysma) branches of the facial nerve (see Figure 4(Fig. 4)) and followed all the criteria to be diagnosed as Bell's Palsy (Fahimi et al., 2014). Finally, during the initial stages of Bell's palsy, the patient's skin showed increased vascularity in the right facial region where the facial nerve branches to its temporal, zygomatic, buccal and mandibular sub-segments (see Figure 4(Fig. 4)).
case_images: Total paralysis of right face with increased swelling, change of skin color, with increased vascularity. This was his condition 11 months post the mRNA vaccination.
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case_images: F4
case_images: There was loss of the normal separative space between the parotid gland and masseter muscle with marked swelling of the muscle and overlying skin thickening up to the inferior aspects of the right ear (Figure 5(Fig. 5)).
case_images: Diffuse mass-like nodularity of right parotid gland superficial and deep portion with swelling, loss of normal plane of separation between the parotid gland and masseter muscle (A). Overlying skin thickening extending up to the inferior aspect of the right ear (B). Small quantity of non-specific soft tissue in right middle ear cavity (C).
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case_images: F5
case_images: The MRI conducted at that time showed a vascular loop approximating to the lateral side of the cranial nerve V exit root (Figures 6(Fig. 6) and 7(Fig. 7)).
case_images: High resolution axial MRI image. The vascular loop runs alongside the left lateral aspects of cranial nerve V (trigeminal) root exit.
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case_images: F6
case_images: The MRI conducted at that time showed a vascular loop approximating to the lateral side of the cranial nerve V exit root (Figures 6(Fig. 6) and 7(Fig. 7)). Otherwise, the brain parenchyma was clear of the presence of any kind of tumor growth; see Figure 7(Fig. 7).
case_images: The left trigeminal V nerve cannot be well visualised as the vascular loop (blue arrow) hides the lateral structures of the left cerebellopontine angle as compared to the right sided trigeminal V nerve (yellow arrows).
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case_images: PMC10620857_01_EXCLI-22-992-g-007.jpg
case_images: F7
case_images: This coexisted with upper eyelid skin inflammation (Figure 8A(Fig. 8)). As the case progressed, this area got increasingly swollen, produced purulent exudates (suggesting a secondary bacterial infection) and skin necrosis (Figure 8B(Fig. 8)), ultimately progressing to an extreme cavitation in the preauricular area with extensive necrosis of the skin (Figure 9(Fig. 9)).
case_images: Eye dryness and irritation. Loss of temperature and touch sensations in ophthalmic and mouth regions. Condition 5 months post the mRNA vaccination (A). Skin necrosis and purulent exudates probably due to secondary bacterial infection. Remarkable change of skin color, edema and increased vascularity. Preauricular cavitation starting to form with inflammatory exudates. Growing mass on zygomatic region (blue arrow). Condition 13 months post the mRNA vaccination (B).
case_images: EXCLI-22-992-g-008.jpg
case_images: PMC10620857_01_EXCLI-22-992-g-008.jpg
case_images: F8
case_images: As the case progressed, this area got increasingly swollen, produced purulent exudates (suggesting a secondary bacterial infection) and skin necrosis (Figure 8B(Fig. 8)), ultimately progressing to an extreme cavitation in the preauricular area with extensive necrosis of the skin (Figure 9(Fig. 9)).