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A rare case of bilateral facial palsy
18 April 2018 (online)
Granulomatosis with polyangiitis (GPA) is a systemic vasculitis with infestation of small and middle arteries. It often leads to necrotizing granulomas of the respiratory system accompanied by a serious glomerulonephritis. Symptoms in the head and neck region such as sinusitis-like complaints or chronic otitis media are common in 90% of the patients at time of diagnosis. The involvement of other organ systems as the eyes or the central nervous system is extremely rare.
A 60-year old woman presented with progressive bilateral peripheral facial palsy. She reported a bilateral otorrhoea starting 5 months ago. Despite multiple antibiotic therapies and the insertion of ventilation tubes a bilateral damage to the inner ear and a facial palsy of the right side occurred. Consequently, a mastoidectomy of the right ear and an intravenous administration of steroids were performed at an external hospital. Further complaints were ageusia and bilateral conjunctivitis. Family anamnesis and serological testing for rheumatic disorders implicated a GPA. Immunosuppressive therapy normalized the inflammation of the ears while the bilateral facial palsy has not improved until today.
The first symptoms of GPA are often complaints in ENT areas. Unspecific symptoms can delay diagnosis. Therefore uncommon differential diagnosis as GPA should be considered in prolonged cases of rhinosinusitis or ear disorders. Quick and adequate treatment can avoid or moderate severe progression of diseases and complications as the bilateral facial palsy.