Metachronous bilateral peripheral facial paralysis

Introduction:

Unilateral peripheral facial palsy is common and usually based on an idiopathic genesis. However, bilateral paresis is a rare condition and may be associated with a significant reduction in quality of life. In these cases many differential diagnoses should be considered. Up to now, there are only a few case reports in the literature on bilateral facial nerve palsy as the first manifestation of Wegener's disease.

Case Presentation:

A 54-year-old male patient presented with left-sided peripheral facial palsy and otitis media. A mastoidectomy with tympanostomy as well as treatment by corticosteroids and antibiotics had already been performed. Thus, a revision of mastoidectomy was performed and histological examination revealed a nonspecific inflammation without evidence of vasculitis. In the further course, the patient developed a tympanic effusion with facial nerve palsy on the right side. In a serological examination c-ANCA and anti-proteinase-3 were positive. Furthermore, a pericarditis was diagnosed by a CT of the thorax. According to the ARA-criteria, the diagnosis of a M. Wegener was made and an immunosuppressive therapy was initiated, which so far did not improve the symptoms.

Conclusions:

In cases of peripheral facial nerve palsy in the context of refractory otitis media, the presence of Wegener's disease should be considered and the appropriate diagnostic timely initiated.

Publication History

Publication Date:
12 June 2019 (online)