Recurrent lower motor neuron type facial palsy: an unusual manifestation of SLE

Dk, Gupta; Atam, Virendra; Chaudhary, Sana

doi:10.1136/bcr.12.2010.3564

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…Another peculiar finding in this case was the bilateral lower motor neuron-type facial paresis, an uncommon peripheral neuraxial manifestation of neuropsychiatric syndromes of SLE. 20 , 21 The pathophysiology of the lower motor neuron-type facial paresis in SLE might be the same as that of myelitis. 2 - 7 , 9 , 10 Herein, thrombotic microvascular occlusion caused by antiphospholipid antibodies was considered as a possibility 20 , 21 ; however, the rapid recovery following rituximab therapy does not support this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

“… 20 , 21 The pathophysiology of the lower motor neuron-type facial paresis in SLE might be the same as that of myelitis. 2 - 7 , 9 , 10 Herein, thrombotic microvascular occlusion caused by antiphospholipid antibodies was considered as a possibility 20 , 21 ; however, the rapid recovery following rituximab therapy does not support this hypothesis. Furthermore, spinal artery thrombosis-related myelitis was ruled out because of the absence of any characteristic pain and imaging abnormalities in this index case.…”

Section: Discussionmentioning

confidence: 99%

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Magnetic resonance imaging-negative myeloneuropathy and bilateral facial paresis unfurling systemic lupus erythematosus

Ghosh

Das

Dubey

et al. 2022

Qatar Medical Journal

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Systemic lupus erythematosus is a chronic autoimmune connective tissue disorder that can affect all the neuroaxes in the central and peripheral nervous systems. Myelopathy in systemic lupus erythematosus is one of the least common neuropsychiatric syndromes accounting for 1%–2% of cases. Myelopathy has long been diagnosed based on clinical findings, laboratory tests, and gold-standard gadolinium-enhanced magnetic resonance imaging (MRI). MRI-negative myelopathy is a recently described subset of myelopathies. Here, we report the case of a young woman from rural West Bengal, India, who presented with overlapping features of white-matter and gray-matter myelopathy associated with peripheral neuropathy and bilateral asymmetric lower motor neuron-type facial paresis. The historical analysis yielded clues toward an etiological diagnosis of systemic lupus erythematosus, further substantiated by seropositivity of lupus-specific autoantibodies. Her neurological disabilities responded poorly to oral administration of hydroxychloroquine, bolus intravenous administration of methylprednisolone, and high-dose cyclophosphamide therapy but eventually responded remarkably well to cyclical rituximab therapy. This case adds to the tally of cases of MRI-negative lupus myelopathy. MRI-negative myelopathy in systemic lupus erythematosus can be easily missed if not meticulous attention is paid during clinical history taking and examinations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging-negative myeloneuropathy and bilateral facial paresis unfurling systemic lupus erythematosus

Ghosh

Das

Dubey

et al. 2022

Qatar Medical Journal

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Unusual aetiology of isolated lower motor neuron facial palsy: systemic lupus erythematosus presenting with cranial nerve palsy and nephritis

Kazzaz

El-Rifai

2013

BMJ Case Reports

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A 20-year-old woman presented with common cold symptoms was found to have a left-sided facial droop. On examination, peripheral facial nerve palsy was confirmed. Subsequent testing showed nephrotic range proteinuria and positive serologies including antinuclear antibody and anti-smith antibody. Kidney biopsy showed stage III lupus nephritis. Treatment with pulse steroids along with mycophenolate mofetil for her lupus nephritis resulted in concomitant improvement of her facial palsy.

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Neurosyphilis Mimicking Connective Tissue Disease

Patel,

Turbin,

Husain

et al. 2023

BMJ Case Rep

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A male in his 60s developed a pruritic, maculopapular rash on his torso and arms, sparing his palms and soles. He tested positive for ANA and an initial skin biopsy identified “bullous lupus,” supporting the diagnosis of a connective tissue disease. Additional symptoms included headaches, facial nerve palsy and hearing loss, which partially responded to oral corticosteroids. He subsequently developed a steroid-dependent left eye scotoma, neuroretinitis and optic nerve papillitis. Mycophenolate mofetil was added but an attempted oral steroid taper led to a worsening rash, progressive retinitis and papillitis. Neurosyphilis was confirmed by serum positive rapid plasma reagin test, reactive treponema pallidum antibodies, positive cerebrospinal fluid venereal disease research laboratory and positive spirochete immunostain of skin biopsy of lesional (rash) tissue. Treatment with intravenous ceftriaxone resolved his rash and visual symptoms. It is important to consider syphilis as a mimicker of connective tissue diseases.

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Recurrent lower motor neuron type facial palsy: an unusual manifestation of SLE

Cited by 3 publications

References 8 publications

Magnetic resonance imaging-negative myeloneuropathy and bilateral facial paresis unfurling systemic lupus erythematosus

Magnetic resonance imaging-negative myeloneuropathy and bilateral facial paresis unfurling systemic lupus erythematosus

Unusual aetiology of isolated lower motor neuron facial palsy: systemic lupus erythematosus presenting with cranial nerve palsy and nephritis

Neurosyphilis Mimicking Connective Tissue Disease

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