A 52-year-old man with a history of hysterectomy at age 8 due to possible B-thalassemia and no cardiovascular risk factors.
Smoker of 1 pack/day and moderate drinker.
Allergic to pyrazolones.
Risky sexual relations in youth
He was admitted for presenting with a chronic dental infection, headache with oral discomfort for a week that had been added 48 hours previously left facial paralysis, sudden onset, bilateral without other symptoms.
On physical examination, the patient presented angioma in the forehead and right eye, together with bilateral parotid swelling.
The initial neurological examination showed bilateral peripheral facial paralysis that caused dysarthria with bilateral Bell's sign.
Lacrimation and hearing were not affected.
Taste disturbance in the anterior third of the tongue.
During the days after admission, paresthesias in the fingers of the hands were added, initially in the upper right limb and then bilateral, and loss of strength in the four limbs of proximal predominance objectifying in the upper right limb tricipit 4/5+ bilateral upper limb.
The clinic continued to progress, adding paresis in the lower extremities 4/5 of the bilateral hips with predominance of right tendinous reflexes with abolished osteotendinous flexors.
Unrelated marching with clumsiness, keeping the march of tiptoes and heels but with weakness in both cuadps.
The chest X-ray showed normal blood count, biochemistry and coagulation.
Serology (Borrelia, Brucella, toxoplasma, rubella, leukes, EBV, CMV, ESR, HIV, Varicella-Zoster, measles and mumps) negative
ACE in blood and immunoglobulin quantification were normal.
Neuroimaging, CT and MRI showed no relevant findings.
The CSF showed increased protein (1.5 gr/dl), without leukocytes and pandy positive with negative cytology.
No oligoclonal bands were observed.
Tensilon test was negative.
ENG was performed on the seventh day of admission where there was no bilateral peripheral facial response with signs of sensory-motor polyneuropathy in extremities, later it was repeated at 14 days persisting type of proximal motor impairment in the proximal limbs.
Initially, treatment with corticoids was established without clear clinical response and, given the progressive evolution of the clinical picture, treatment with IV immunoglobulins was established for 5 days (28 g/day), with no progression to mild clinical remission.
After six months, the patient showed complete improvement in both facial paralysis and limb weakness, not requiring continued rehabilitation treatment.
