Peripheral facial palsy in elderly: Not always a benign condition

摘要

A 73-year-old woman was admitted to our Department with inability to close her right eye, disappearance of the nasolabial fold, drop of the mouth to the left side and loss of taste sensation of 40 days duration. Based on these symptoms, Bell's palsy was diagnosed by her primary care physician 38 days prior to her admission. The patient received acyclovir 400 mg five times per day and steroids (50 mg/day prednisolone) for 10 days, but without any improvement. Her doctor had noticed the presence of enlarged cervical lymph nodes, but he had considered that further evaluation was not necessary. The patient was free from any other medical problems, but she had noticed weight loss and low appetite during the last 3 months. On admission, the clinical examination revealed fever (38C), neurological findings compatible with right peripheral facial paresis without hyperacusia, hearing disturbance or less lacrimation, while cervical and axillary lymphadenopathy was noticed. The lymph nodes were firm, rubbery and non-tender. The liver and spleen were not enlarged. Laboratory findings included: hematocrit, 33.6%; white blood cells, 13 400 mm3; erythrocyte sedimentation rate, 119/lsth; C-reactive protein, 203 mg/dL; lactic dehydrogenase, 775 IU/L. Serological tests for Toxoplasma, Epstein-Barr virus and cytomegalovirus were negative for acute infection.