Antinuclear antibody negative systemic lupus erythematosus presenting as bilateral facial paralysis.

Cranial neuropathy, and particularly facial palsy, is a rare occurrence in patients with systemic lupus erythematosus (SLE). We describe a 16-year-old female who developed bilateral facial palsy concomitant with cutaneous bullous eruption, alopecia, mucosal ulcers, arthritis, lymphadenopathy, parotid enlargement, and proteinuria. The lack of positive antinuclear antibody (ANA) at presentation obscured the diagnosis. Her followup course clarified the diagnosis of SLE. We believe this is the first report of ANA negative SLE presenting as bilateral facial palsy.