Clinicopathological Conference
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2014; 2(6): 235-239
Published online Jun 16, 2014. doi: 10.12998/wjcc.v2.i6.235
Facial nerve palsy, headache, peripheral neuropathy and Kaposi’s sarcoma in an elderly man
Dimitrios Daoussis, Elisabeth Chroni, Athanassios C Tsamandas, Andrew P Andonopoulos
Dimitrios Daoussis, Andrew P Andonopoulos, Division of Rheumatology, Department of Internal Medicine, University of Patras School of Medicine, 26504 Patras, Greece
Elisabeth Chroni, Department of Neurology, University of Patras School of Medicine, 26504 Patras, Greece
Athanassios C Tsamandas, Department of Pathology, University of Patras School of Medicine, 26504 Patras, Greece
Author contributions: Daoussis D and Andonopoulos AP conceived the idea of the study, performed the clinical assessments and drafted the manuscript; Chroni E performed the nerve conduction studies and assisted in manuscript drafting; Tsamandas AC performed all histological assessments and assisted in manuscript drafting.
Correspondence to: Dimitrios Daoussis, MD, Assistant Professor of Internal Medicine/Rheumatology, Division of Rheumatology, Department of Internal Medicine, University of Patras School of Medicine, Rion, 26504 Patras, Greece. jimdaoussis@hotmail.com
Telephone: +30-2613-603693 Fax: +30-2610-993982
Received: February 12, 2014
Revised: March 26, 2014
Accepted: April 17, 2014
Published online: June 16, 2014
Processing time: 128 Days and 15 Hours
Abstract

We present a case of an elderly man, who initially presented with right facial nerve palsy, ipsilateral headache, elevated erythrocyte sedimentation rate (ESR) and no fever. A presumptive diagnosis of giant cell arteritis was made and the patient was treated with high-dose steroids. A temporal artery biopsy was negative. Several months later, while on 16 mg of methylprednisolone daily, he presented with severe sensorimotor peripheral symmetric neuropathy, muscle wasting and inability to walk, uncontrolled blood sugar and psychosis. A work-up for malignancy was initiated with the suspicion of a paraneoplastic process. At the same time a biopsy of the macular skin lesions that had appeared on the skin of the left elbow and right knee almost simultaneously was inconclusive, whereas a repeat biopsy from the same area of the lesions that had become nodular, a month later, was indicative of Kaposi’s sarcoma. Finally, a third biopsy of a similar lesion, after spreading of the skin process, confirmed the diagnosis of Kaposi’s sarcoma. He was treated with interferon α and later was seen in very satisfactory condition, with no clinical evidence of neuropathy, normal muscle strength, no headache, normal electrophysiologic nerve studies, involution of Kaposi’s lesions and a normal ESR.

Keywords: Facial nerve palsy; Peripheral neuropathy; Vasculitis; Paraneoplastic syndrome; Kaposi’s sarcoma

Core tip: We present a case of an elderly man, who initially presented with right facial nerve palsy, ipsilateral headache, elevated erythrocyte sedimentation rate and no fever. A presumptive diagnosis of giant cell arteritis was made and the patient was started on high-dose steroids. Several months later, he presented with severe sensorimotor peripheral symmetric neuropathy. A biopsy of the macular skin lesions that had appeared almost simultaneously, was suggestive of Kaposi’s sarcoma. Although peripheral and cranial nerve involvement has not been reported in Kaposi’s sarcoma, we postulate that the patient’s condition could be attributed to that, within the context of a paraneoplastic process