Melkersson-Rosenthal syndrome: elevations in serum angiotensin converting enzyme and results of treatment with methotrexate.

We have presented the case of a 37-year-old white man who had recurrent, unilateral, facial edema, temporary partial facial nerve palsy, sensory loss along the ophthalmic and maxillary divisions of the fifth cranial nerve, ageusia bilaterally on the anterior two thirds of the tongue, right extraocular muscle palsies, and intractable migraine-type headaches, leading to the diagnosis of Melkersson-Rosenthal syndrome. The serum angiotensin converting enzyme levels, which are postulated to derive from undiscovered granulomas, were found to be elevated. Methotrexate therapy mitigated the clinical course of the disease, and may prove to be useful in the treatment of this rare and recalcitrant condition.