Bilateral facial palsy due to Melkersson-Rosenthal syndrome

A 29-year-old woman developed bilateral facial nerve palsy for which no cause could be identified despite neuroimaging, lumbar puncture, viral serology and blood testing. Neuroinflammatory and dermatology input was sought. The patient later presented with a new manifestation of upper lip swelling, leading to a clinical diagnosis of Melkersson-Rosenthal syndrome. The diagnosis of this neuromucocutaneous disorder is challenging, with the classical triad of signs-facial nerve palsy, orofacial oedema, lingua plicata-often not presenting together. Suspecting the condition in oligosymptomatic presentations could reduce the delay in diagnosis, thereby facilitating earlier consideration for corticosteroid or immunosuppressive treatment and involvement of dermatology as appropriate.