Melkersson–Rosenthal syndrome: A rare cause of recurrent facial palsy – A case report

Abstract

Background: Melkersson–Rosenthal syndrome is a rare, neuro-mucocutaneous, granulomatous disorder of unknown etiology, clinically characterized by a triad of symptoms: recurrent facial nerve palsy, facial swelling and fissured tongue. Melkersson–Rosenthal syndrome is frequently seen in patients in their second or third decade of life. It is diagnosed based on clinical features, and it is rarely possible to observe all the classic triad symptoms at the same time. The disorder may cause recurring peripheral facial palsy that is wrongly diagnosed as recurrent Bell’s palsy.

Case presentation: A 25-year-old female patient, referred from Bishoftu town in Ethiopia, was presented to the neurology clinic of Tikur Anbessa Specialized Hospital in Addis Ababa complaining of a five-day history of recurrent left-side peripheral facial weakness, facial edema and fissured tongue. Her past medical history was positive for similar symptoms, for which she was diagnosed with Bell’s palsy and received oral corticosteroid treatment. Left-side lower facial swelling with flat naso-labial fold and fissured tongue were detected on examination. After excluding other mimickers, she was diagnosed with Melkersson–Rosenthal syndrome and completely recovered with a high dose of steroid treatment.

Conclusion: Melkersson–Rosenthal syndrome may present with the classic clinical triads of symptoms, but mostly it shows an oligosymptomatic pattern. So, it is usually under-recognized and often misdiagnosed as Bell’s palsy, as had been done in the past in our case. Therefore, Melkersson–Rosenthal syndrome should be considered in the differential diagnosis of patients presented with recurrent peripheral facial weakness, as early detection and therapy might prevent cosmetic disfigurement from multiple relapses [Ethiop. J. Health Dev. 2020; 34(3): 214-216]

Key words: Melkersson–Rosenthal syndrome, facial palsy, fissured tongue, facial swelling, Bell’s palsy