Presentation of Bilateral Facial Paralysis in Melkersson-Rosenthal Syndrome.

Gustavo Gaitan-Quintero,Loida Camargo-Camargo,Norman López-Velásquez,Peter Berlit,Miguel González

doi:10.1155/2021/6646115

Abstract

Introduction. Melkersson–Rosenthal syndrome (MRS) is a neuromucocutaneous disorder characterized by the following classic symptom triad: peripheral facial paralysis, orofacial edema, and scrotal or fissured tongue. It is rare, and since most of the patients are oligo- or monosymptomatic, it makes it difficult to diagnose. Clinical Case. We present a 26-year-old male patient with a history of sickle cell trait, untreated snoring, and left peripheral facial paralysis when he was 11 years old. This was an overall 20-day clinical profile that started with left peripheral facial paralysis, which was accompanied by moderate-intensity occipital pulsatile headaches. Additionally, the patient experienced paresthesias in the tongue and feelings of labial edema. After one week, he manifested peripheral facial paralysis on the right side. Physical examination revealed bilateral peripheral facial paralysis, mild labial edema, and a scrotal or fissured tongue. The patient received corticosteroids, which resulted in improvement of the edema and facial paralysis. Discussion. MRS is a rare disorder that predominantly affects women, typically starting in their 20s or 30s. The etiology is unknown. However, a multifactorial origin that involves environmental factors and a genetic predisposition has been proposed, which causes a dysfunction of the local immune system and autonomic nervous system (ANS) and an appearance of granulomatous inflammation in the lips and tongue. Facial paralysis usually appears later on; however, it can occur from its clinical debut. There are no curative treatments. Therapy is focused on modulating the patient's immune response, and relapses are frequent.

Highlights

Melkersson–Rosenthal syndrome (MRS) is a neuromucocutaneous disorder characterized by the following classic symptom triad: peripheral facial paralysis, orofacial edema, and scrotal or fissured tongue
We present a case of MRS in a male patient who came with bilateral facial paralysis and who was diagnosed with sickle cell trait
Melkersson–Rosenthal syndrome (MRS) is a rare disorder described for the first time in 1929 by Ernst Gustaf Melkersson as peripheral facial paralysis and edema in the lips

Summary

Introduction

Melkersson–Rosenthal syndrome (MRS) is a neuromucocutaneous disorder without a known etiology. We present a case of MRS in a male patient who came with bilateral facial paralysis and who was diagnosed with sickle cell trait. 2. Clinical Case e patient is a 26-year-old Afro-Colombian male with a history of sickle cell trait and left peripheral facial paralysis from when he was 11 years old. Clinical Case e patient is a 26-year-old Afro-Colombian male with a history of sickle cell trait and left peripheral facial paralysis from when he was 11 years old He came for a 20-day clinical profile development that started with feelings of weakness in the right half of the face, causing difficulties in palpebral closure. E physical exam showed evidence of peripheral bilateral facial paralysis, House Brackmann 2 on the left side and 3 on the right side, slight labial edema, and a scrotal or fissured tongue (Figure 1). Case Reports in Neurological Medicine mastoid process, feelings of paresthesias in the tongue, and labial edema. e following week, he started to manifest contralateral weakness on one side of his face and the inability for palpebral closure. e physical exam showed evidence of peripheral bilateral facial paralysis, House Brackmann 2 on the left side and 3 on the right side, slight labial edema, and a scrotal or fissured tongue (Figure 1). e blood analysis was normal, expect for sickle cell trait. e cerebral MRI did not present any alternations. e patient was treated with oral prednisolone for 7 days and resulted in complete symptom improvement of his facial paralysis and labial edema

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