Unilateral facial swelling - pls help

Posted by gnandanpai @gnandanpai, Feb 5, 2022

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

SYMPTOMS:
- 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.

HISTORY:
- 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.

RECENT VACCINATIONS:
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.

AUTO-IMMUNE:
- 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.

CANCER:
- 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.

Interested in more discussions like this? Go to the Autoimmune Diseases Support Group.

@amandaa

Hi @fisherslady and welcome to Mayo Clinic Connect. You'll see that I moved your post to a discussion talking about facial swelling.
There is also another discussion going on here: Facial Swelling - no diagnosis after 2 years:https://connect.mayoclinic.org/discussion/facial-swelling-no-diagnosis-after-2-years/

Are you currently keeping a log of when it flares up? Have you noticed any consistencies?

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I have had no relief for more than 5 weeks. No meds help. Just finished a week of Keflex. With no improvement. Steroid shots don't work anymore. Yes I am keeping a log. My only hope today is a diagnosis. I think HAE is the closest I have found. Noone, dermatologist or internist have ever mentioned it.

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I am retaining fluid on the left side of my face, swelling inside of left ear. Also under left chin, under my eye. I have had this for a while now. Going for a CT Scan soon. My doctor's have no idea what it is. Anyone???

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@susant75

I am retaining fluid on the left side of my face, swelling inside of left ear. Also under left chin, under my eye. I have had this for a while now. Going for a CT Scan soon. My doctor's have no idea what it is. Anyone???

Jump to this post

Hi @susant75, this must be concerning. I moved your message to this existing discussion that seems similar to your issue of unilateral swelling of the face, ear and neck. See the previous posts here:
- Unilateral facial swelling - pls help https://connect.mayoclinic.org/discussion/unilateral-facial-swelling-pls-help/

You may also find some helpful ideas in this discussion:
- Facial Swelling – no diagnosis after 2 years: https://connect.mayoclinic.org/discussion/facial-swelling-no-diagnosis-after-2-years/

Susan, I believe that you also have diabetes judging from something you posted elsewhere. Do you have type 1 or type 2? Have you talked to your endocrinologist about this? Has autoimmune been ruled out?

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@susant75

I am retaining fluid on the left side of my face, swelling inside of left ear. Also under left chin, under my eye. I have had this for a while now. Going for a CT Scan soon. My doctor's have no idea what it is. Anyone???

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I retain fluid in my face all the time. Following

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@pittsburgh11

I retain fluid in my face all the time. Following

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Do you know what causes that?

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@susant75

Do you know what causes that?

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There are numerous things that can cause it. That's why I am following.

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Maybe read up on the sphenoid sinus. Can cause multiple problems if blocked by bacteria or fungus. Am planning to try to discuss it with my doctor, since my severe cough has returned after 2 years without. ( A common for months every year for 25+ yes. ) I can breathe fine through my nose , so sinusitis is usually ruled out even though constant drainage. The sphenoid secret little sinus has never been mentioned, even though it can cause multiple, severe problems.
Good luck.
Keep posting please to let us know what you find.
Thanks.

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@fisherslady

I have dealt with this on and off for 4 years. Dermatologist had me on prednisone, got Prednisone rosacea. Use all hypoallergenic products. Face swells, hot, red blotches eyes, nose chin, neck. Like a sunburn, extra dry. Cream makes it worse. only relief is ice paks. Prednisone shots helped once , not anymore. Keflex helped once and not anymore. No answers from anyone. I am currently looking into hereditary angioadema. Has anyone experienced this?

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About two weeks ago I woke up to both sides of my lower face swollen. A week after that, again on both sides of my neck near the shoulders, I had large bulges .I thought all this strange that these all appeared at the same time. CT scan addresses the check swelling and shoulder/neck swelling as Buccal Fat Pads. Although my doctor thought the latter were encapsulated fatty tumors or cysts. The only remedy is surgical removal, needle aspiration or liposuction . Since I am now seeing similar situations on this site, can I attribute this to Long Covid? I will see if they go down or just disappear as they appeared.

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