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Bilateral Facial Palsy: A Rare Presenting Symptom for Inclusion Body Myositis
Elana Meer1, Meleha Ahmad1,2, Seanna Grob1,2
1Department of Ophthalmology, University of California, San Francisco, California, U.S.A.
Ophthalmic Plastic and Reconstructive Surgery
|February 6, 2024
Summary
Inclusion body myositis typically affects older adults with limb weakness. This case highlights a rare presentation with severe facial palsy, emphasizing its importance in differential diagnosis.
Area of Science:
- Neurology
- Ophthalmology
Background:
- Inclusion body myositis (IBM) is a progressive inflammatory myopathy primarily affecting individuals over 50.
- Classic IBM symptoms include progressive weakness and atrophy in forearm and quadriceps muscles.
- Facial weakness is uncommon, and severe facial palsy is exceptionally rare in IBM.
Observation:
- A unique case of IBM presented initially with severe bilateral facial palsy and exposure keratitis.
- The patient exhibited minimal limb weakness, deviating from the typical IBM presentation.
- Symptoms included symmetric paralytic lagophthalmos leading to corneal exposure.
Findings:
- This presentation is distinct from previously reported cases, particularly the bilateral facial palsy and symmetric lagophthalmos.
- The case challenges the classic understanding of IBM's typical clinical manifestations.
- Diagnostic considerations for bilateral facial palsy must include IBM.
Implications:
- This case underscores the need to consider Inclusion Body Myositis in the differential diagnosis of bilateral facial palsy.
- Ophthalmologists and neurologists should be aware of this rare but possible presentation of IBM.
- Early recognition can potentially lead to timely management and prevent complications like corneal damage.
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