Unilateral facial swelling - pls help
Hello, I am new to the forum so pardon any breaking of rules. I am not yet diagnosed with an auto-immune disorder. However, I did not know where else to post about my conditions. I have done my best to provide a clear synopsis below. If anyone faces something similar and has tips I much appreciate it!
—— SYNOPSIS ——–
44 yr old otherwise healthy male
– Recurrent (4 episodes in 7 weeks) UNILATERAL (RIGHT) CHEEK & UPPER-LIP diffused swelling.
– Initially, self-resolving (duration: 3-14 days), though the last (4th) episode is still persistent after 14 days.
– 4th episode has area UNDER & LATERAL (eye-lid NOT involved) to the RIGHT EYE involved as well.
– NO OTHER SYMPTOMS …
– NO pain/tenderness & erythema.
– NO fever.
– NO headache.
– NO nasal congestion, runny nose or any other upper respiratory symptoms.
– NO troubled breathing, swallowing or eating.
– NO pain in gums or teeth while chewing or otherwise; the Dentist did not find anything remarkable during his evaluation and read of panoramic dental x-rays.
– NO tingling/numbness/paralysis.
– NO palpable hard mass.
– NO fatigue.
– NO unintentional weight loss.
– NO PERSONAL history of allergies; no exposure to any new foods or chemicals; no travel (Zyrtec, Benadryl, Flonase, Saline Spray did not *seem* to improve symptoms).
– NO PERSONAL history of sinusitis.
– NO change in medication (current medication are Finasteride 1mg & Minoxidil 5% for Alopecia which I have used for over 20 years without issues).
– NO trauma.
COVID-19 – April 7th 2021, May 5th 2021, Nov 30th 2021
Tdap – Sept 16th 2021
Flu – Oct 28th 2021
HPV – Sept 16th 2021, Oct 28th 2021, the final dose is scheduled for Mar 15th 2022.
– FAMILY HISTORY of auto-immune: [Vitiligo (Mom & both maternal grandparents), Grave's disease (maternal uncle), Diabetes (mom), Alzheimer's (maternal grandmother) etc].
– PERSONAL HISTORY of auto-immune: Alopecia Areata (auto-immune disorder) since 2017.
– FAMILY HISTORY of cancer: Maternal aunt died of Lymphoma.
-General dentist did not find anything via oral evaluation & panoramic x-rays. He recommended visiting Oral Surgeon as the next step.
-ENT did not find anything via nasal endoscopy.
– ENT ordered a CAT scan (w/o contrast) of the sinus area, which found "Polypoid mucosal thickening" in sinuses. CAT scan ruled out any tumour, cyst, abscess in the area. However, ENT did not think that the sinus issues explain the facial swelling. He prescribed oral antibiotics (Augmentin) & oral steroids (Prednisone) and recommended visiting a Rheumatologist & Immunologist as the next steps. I have NOT started the antibiotics or steroid course just yet (preferring to get a solid diagnosis first).
– Visited Immunologist. She did allergy tests but nothing interesting came up except a very mild allergy to pine, roaches, rats & feathers. She ordered blood work & urine tests. Results were unremarkable except for mildly elevated IgA (348). She also prescribed Allegra in the meantime which as of yet has had no effect.
– Visited Oral Surgeon. He said he had no ideas about what was going on, but ruled out any dentition, oral tumour, cyst, abscess, salivary gland issues, TMJ issue etc. He did not recommend a biopsy until there is more imaging or evolution. He said MRI of the face w/ and w/o contrast, may be useful but taken only when my swelling is at its most extreme (logistically challenging given swelling is up and down, and MRI has wait time w/ insurance pre-auth). He suggested an option to go to ER for the MRI when swelling is at its worst.