Hyperbaric oxygen therapy for post-partum bell's palsy associate with anti-phospholipid syndrome: a case report, literature review, and mechanistic insights

Background: Bell's palsy, the most common cause of acute facial paralysis, can occur more frequently during pregnancy and postpartum due to physiological changes such as fluid retention, hormonal shifts, and immune modulation. Antiphospholipid syndrome (APS), an autoimmune disorder characterized by thrombosis and pregnancy related complications, further increases the risk of microvascular ischemia affecting cranial nerves. Case presentation: We report the case of a 37-year-old woman with longstanding APS who developed postpartum Bell's palsy unresponsive to corticosteroid therapy. Despite receiving 60 mg of prednisone, no clinical improvement was noted. Hyperbaric oxygen therapy (HBOT) was initiated, prescribed for 20 sessions at 2 absolute atmospheres, 5 days per week. Remarkable improvement was observed after the first session, with complete symptom resolution by the twelfth session. Additionally, anti-dsDNA antibodies, previously positive during pregnancy, became negative following HBOT. Conclusion: HBOT may represent a valuable adjunctive treatment for postpartum Bell's palsy in high-risk populations such as those with APS, offering combined benefits of enhanced oxygenation, inflammation control, and vascular repair. Further prospective studies are warranted to validate these findings and define standardized treatment protocols.