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Letter to the Editor
Bilateral facial nerve palsy associated with p-ANCA positive vasculitis in a patient with rheumatoid arthritis
  1. OWEN G STEWART,
  2. IAN G SIMMONS,
  3. MIKE F R MARTIN,
  4. ANDREW J MORRELL
  1. Department of Ophthalmology, Leeds General Infirmary, Clarendon Wing, Leeds LS2 9NS, UK
  1. Mr Stewart owenstewart{at}fsmail.net

https://doi.org/10.1136/bjo.85.10.1260g

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    Editor,—Rheumatoid arthritis is a chronic, generalised, symmetrical, inflammatory polyarthritis. Extra-articular associations may involve the eyes, heart, lung, skin, and more rarely, the central and peripheral nervous system. We describe a case of bilateral facial paresis associated with a p-ANCA positive vasculitis in a patient with rheumatoid arthritis.

    CASE REPORT

    A 67 year old woman presented with 2 days of left sided facial weakness. She was known to suffer from rheumatoid arthritis, and displayed the characteristic hand and finger deformities of this condition. Additional features of vitiligo, hypothyroidism, and splenomegaly were present. Her medication consisted of methotrexate 5 mg weekly, thyroxine 100 μg once daily, and folic acid 5 mg once daily. Examination revealed isolated left sided lower motor neuron facial nerve paresis, and a left Bell's palsy was diagnosed. One week later, she returned with right sided facial weakness. No improvement on the left side had occurred and bilateral lower lid paralytic ectropion …

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