Melkersson-Rosenthal syndrome as an early manifestation of mixed connective tissue disease

Abstract

Purpose of review: We aim to illustrate the potential viability of MCTD as an underlying aetiology of Melkersson-Rosenthal syndrome. The case is probably the first description available in the literature of the Melkersson-Rosenthal as an early manifestation of mixed connective tissue disease.

Recent findings: The Melkersson-Rosenthal syndrome consists of a triad of recurrent lip and/or face swelling, fissured tongue, and intermittent facial palsy. Mixed connective tissue disease is a multisystemic disorder with overlapping features of systemic lupus erythematosus, scleroderma, and polymyositis, and is differentiated from them by a high titer of antibodies to ribonucleoprotein. The paper presents a case report of Melkersson-Rosenthal syndrome with an onset in childhood that derived from vasculitis that turned out to be an early manifestation of mixed connective tissue disease. We used MRI to evaluate patient's brain structure and Immunoblot Ena Profil 1 test to test serum autoantibodies level. The patient has a typical for Melkersson-Rosenthal syndrome triad of symptoms: bilateral facial nerve palsy, lingua plicata and facial oedema. Both TC and MRI of the head show no changes as well as laboratory tests except Anti-SS-A (Anti-Ro) and Anti-RNP autoantibody serum level that was highly positive. Neurological involvement of the MCTD usually includes, according to the frequency of the occurrence, trigeminal neuralgia, headaches, sensorineural hearing, cerebral haemorrhage, transverse myelitis, cauda equina syndrome, retinal vasculitis, progressive multifocal encephalopathy, and demyelinating neuropathy. For clinical practice it is important to remember that Melkersson-Rosenthal syndrome can also be the neurological manifestation of MCTD, especially when accompanied by other systemic symptoms.

Fig. 1

Patient’s daughter. Lingua plicata (or fissured tongue). One of the triad of the symptoms of Melkersson–Rosenthal syndrome that consist of recurrent lip and/or face swelling, fissured tongue, and intermittent facial palsy

Fig. 2

Patient. Smooth left nasolabial furrow. After bilateral facial nerve palsy patient is unable to smile

Fig. 3

Patient. Lingua plicata (or fissured tongue). One of the triad of the symptoms of Melkersson–Rosenthal syndrome that consist of recurrent lip and/or face swelling, fissured tongue, and intermittent facial palsy