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Rare case of Melkersson-Rosenthal Syndrome treated with 5-fluorouracil- A report
David M. Alessi and colleagues from the Alessi Institute, Los Angeles, CA, USA recently reported an interesting case of Melkersson-Rosenthal syndrome, or orofacial granulomatosis where the patient was treated with 5-fluorouracil and responded positively.
The report is published in the Ear, Nose and Throat Journal.
The rarity of Melkersson-Rosenthal syndrome, or orofacial granulomatosis, can present with persistent midface bogginess. The management for previous reported cases has included corticosteroid injections, antihistamines, and antibiotics.
Chronic orofacial edema can result from a multitude of etiologies, such as those of an infectious, inflammatory, or allergic origin, among others. A proper history intake, as well as thorough physical examination, can inform the clinician both as to the cause and the most appropriate and efficacious management approach.
The authors studied the report of a 45-year-old male presented with welts under his eyes with associated thickening of the buccal space of 8 months duration. The patient presented with no significant past medical history aside from occasional hay fever, had no history of trauma or surgery, and denies any pertinent social or family history.
The patient received a Botox injection about 5 years prior and states that there was no concurrent use of dermal fillers. He was previously treated with steroid creams, antibiotics, and oral steroids without any improvement.
Magnetic resonance imaging, computed tomography of the sinuses, and chest X-ray were negative, and the patient was referred to facial plastics for surgery.
Given the involvement of the buccal space, an anterior buccal biopsy was performed that demonstrated noncaseating granulomas and scattered perivascular inflammatory cells, confirming the diagnosis of orofacial granulomatosis, otherwise known as Melkersson-Rosenthal syndrome. Treatment of injection with 5-fluorouracil (5-FU) in the region (0.1-0.5 cc at a concentration of 50 mg/mL) was done.
3-4 months of follow up yielded positive results. Additionally, the patient has not shown signs of steroid atrophy.
As a result, it was observed that injections with 5-fluorouracil can be used for the management of patients presenting with Melkersson-Rosenthal syndrome.
https://doi.org/1001455613211038391
BDS, MDS( Pedodontics and Preventive Dentistry)
Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751