Recurrent Facial Palsy with Orofacial Swelling in a Young Female: A Case of Melkersson–Rosenthal Syndrome

Background: Melkersson–Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous disorder characterized by a classical triad of recurrent facial nerve palsy, orofacial edema, and fissured tongue. Owing to its variable and often incomplete clinical presentation, the condition poses a diagnostic challenge and is frequently underrecognized. Diagnosis is primarily clinical and relies on exclusion of other neurological, infectious, and granulomatous disorders. Case Presentation: We report the case of a 23-year-old female who presented with a three-year history of recurrent left-sided lower motor neuron facial palsy associated with intermittent, painful swelling of the upper and lower lips. The episodes occurred every few months and lasted approximately two to three weeks. Clinical examination revealed unilateral facial weakness, recurrent orofacial edema, and a fissured tongue. Extensive laboratory investigations, autoimmune screening, and magnetic resonance imaging of the brain were unremarkable, excluding alternative etiologies. Based on the characteristic clinical features and exclusion of other causes, a diagnosis of Melkersson–Rosenthal syndrome was established. Results: The patient was initially managed with oral corticosteroids during acute episodes, resulting in significant symptomatic improvement. Due to the recurrent nature of the disease, long-term immunosuppressive therapy with azathioprine was initiated. At six-week follow-up, the patient demonstrated a marked reduction in the frequency and severity of facial palsy episodes, significant resolution of orofacial swelling, and improvement in tongue-related discomfort, leading to enhanced quality of life. Conclusion: This case highlights the importance of clinical awareness and early recognition of Melkersson–Rosenthal syndrome in patients presenting with recurrent facial palsy and orofacial swelling. Prompt diagnosis and appropriate immunomodulatory therapy can effectively control symptoms, reduce recurrence, and improve long-term outcomes in affected individuals. Keywords: Fissured Tongue, Immunosuppressive Therapy, Melkersson–Rosenthal Syndrome, Orofacial Edema, Recurrent Facial Palsy.