Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website http://www.journalmc.org

Case Report

Volume 9, Number 9, September 2018, pages 303-308


Melkersson-Rosenthal Syndrome Still a Mystery: A Case Report and Suggested Guideline Investigations

Figures

Figure 1.
Figure 1. (a, b) Right side edema with swollen upper lip. (c, d) Fissured tongue, gingival hypertrophy. (e, f) Facial nerve examination; flattened right forehead, weakness in closing the right eye. (g, h) CT scan showing right side facial swelling and upper lip swelling.
Figure 2.
Figure 2. Biopsy from upper lip (mucosa).

Tables

Table 1. Investigations
 
InvestigationaResults
ACE: angiotensin-converting antibody; C3, C4: third and fourth components of complement; HIV: human immunodeficiency virus; RAST: radioallergosorbent test; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; TG: thyroglobulin; TPO: thyroid peroxidase; TTG: tissue transglutaminase; CCP: cyclic citrullinated peptide; ANCA: anti-neutrophilic cytoplasmic antibody; PPD: purified protein derivative. aPlanned to be performed if symptoms of facial palsy persisted, but the patient missed the follow-up appointment: C1 esterase inhibitor, ANCA, immunoglobulin E, total iron profile, chest plain radiography, PPD (for tuberculosis), hepatitis C, serum cryoglobulins, patch test, head magnetic resonance imaging.
Complete blood countNormal
CRPMildly elevated: 12.5 mg/L (normal: 0 - 3.0)
Normalized after steroid course (1.3 mg/L)
ESRNormal
Thyroid function testsNormal
Anti-TG antibodies, anti-TPO antibodiesNegative
Renal function testsNormal
TTG, anti-gliadin antibodyNegative
Anti-CCPNegative
C3Normal
C4Mildly decreased. 0.13 g/L (normal 0.17 - 0.52)
Antinuclear antibodyNegative
HIVNegative
RAST for chicken meat, mutton, and beefNegative
ACE levelNormal
Rheumatoid factorNegative

 

Table 2. Suggested Guideline Investigations
 
ACE: angiotensin-converting antibody; C3, C4: third and fourth components of complement; RAST: radioallergosorbent test; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; TTG: tissue transglutaminase; ANCA: anti-neutrophilic cytoplasmic antibody; PPD: purified protein derivative.
CBC, ESR, CRP
Renal and liver function tests
Total immunoglobulins, subgroups
Thyroid function tests, thyroid antibodies
Anti-gliadin, TTG
C3, C4 levels
Antinuclear antibody, ANCA, renal function tests
C1 esterase inhibitor
ACE level
Chest plain radiography, PPD (for tuberculosis)
Biopsy to determine histopathology and to guide screening for microbial agents
Detailed history, including the first symptom of the triad to appear, number of years having the disease, when the biopsy was done, treatment used, number of relapses