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

Abstract

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.

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

“…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.…”

“… 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.…”

Simultaneous Oculomotor and Facial Nerve Palsies in a Patient with Systemic Lupus Erythematosus and Sjögren’s Syndrome

“…A recent review of NPSLE indicated that cranial neuropathy is a rare manifestation (0.5–1%) [4]. Several dozen case reports on peripheral cranial nerve palsy have been reported in patients with SLE [5–7].…”