International Journal of Clinical Case Report, 2016, Vol.6, No.16, 1-4
4
age group are reported in the literature till date (Gürkan et al., 2015). Literature shows a male to female ratio of
1:3. In the present case, an 8 years old male patient reported with the classic triad of MRS, which is again rare.
Cases reported till date in the literature did not show all the features of the triad. They either showed facial palsy,
facial edema without lingua plicata or facial edema and lingua plicata without facial palsy or facial palsy and
lingua plicata without facial edema. There is no standardized protocol in literature regarding the treatment of MRS
patients. Systemic corticosteroids, 1mg/kg/day, have been found to be effective in many cases (Gürkan et al.,
2015). Intra-lesional glucocorticoids, triamcinolone acetonide, 40 mg once a week for 3 weeks, for lip edema has
also been found to be effective (Critchlow and Chang, 2014). Metronidazole, clofazimine, roxithromycin,
combination of dapsone and triamcinolone are effective in cases of cheilitis granulomatosa. If cheilitis
granulomatosa is not responding to the conservative treatment, surgery followed by intra-lesional steroids for 2 to
6 months, found to be effective (Agarwal et al., 2011). For cosmetic purpose, reconstructive surgery of lip is
indicated. For facial palsy not responding to medical treatment, surgical decompression of the nerve throughout its
bony canal is indicated (Ozgursoy et al., 2011). In patients complaining of burning sensation with fissured tongue,
symptomatic treatment with topical steroids is indicated. With the treatment including topical, systemic or
intra-lesional steroids, 60% to 80% regression of the disease is noted although recurrence is still noted in 60% to
75% of the cases (Agarwal et al., 2011). In our patient, intra-lesional injections of 0.1% triamcinolone acetonide
were given at multiple sites for a period of 10 weeks in lower lip. For facial palsy and lingua plicata, no treatment
was indicated as the patient was more concerned for the lip swelling
Conclusion
The diagnosis of facial palsy is often challenging in patients of Melkersson-Rosenthal syndrome where in, in most
of the cases, it is often misdiagnosed. A detailed history and clinical examination are often necessary for an
accurate diagnosis of Melkersson-Rosenthal syndrome. A close follow-up is also mandatory as it is having a high
recurrence rate.
Acknowledgment
The research grant for this study was provided by the National Commission for Science, Technology and Innovation, Kenya, awarded
to Muthumbi A., Kihia C.M., and Okondo J. Institutional support and laboratory facilities provided by Nairobi and Egerton
universities, Kenya Marine and Fisheries Institute are appreciated. Members of the Mida Creek Conservation Community, especially
Mwamure J., assisted in introduction to fishers. Nthiga A. and Njuguna V. (Msc Students University of Nairobi students), participated
in both field and laboratory work. Ngatia J., Muhamed S., and Abutrika M. (University of Nairobi Bsc students), participated in
fieldwork. Discussions on commerce and economics with Drs. Thronjo E., (JKUAT), M Kariuki M., (EU) and Wagoki J. (JKUAT),
provided useful guidelines. The contributions and suggestions made by the reviewers are also appreciated.
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