title: Recurrent attacks of facial nerve palsy as the presenting sign of leukemic relapse.
abstract: OBJECTIVE
  To present an unusual case of recurrent facial palsy resulting from acute leukemic infiltration of the parotid gland.
  
  
  METHODS
  Case report.
  
  
  METHODS
  An 11-year-old boy who had been treated for acute lymphoblastic leukemia (ALL) from 3 to 6 years of age presented with intermittent left facial nerve palsy with concurrent ipsilateral parotid fullness. The initial findings at diagnosis and workup are presented, and the disease progression and resolution with therapy are documented.
  
  
  RESULTS
  The patient had been off therapy when this finding developed. A workup for central and viral etiologies for the facial palsy was unrevealing. Biopsy of the parotid gland demonstrated a lymphoblastic leukemic infiltrate. The patient was placed on a chemotherapy protocol for relapsed leukemia, resulting in complete resolution of the facial palsy.
  
  
  CONCLUSIONS
  Isolated facial nerve dysfunction, albeit rare, has been documented as a sign of central nervous system involvement in leukemia, but until now this presentation has not been described in the setting of leukemic relapse presenting with acute infiltration of the parotid gland.
authors.affiliation: Department of Otolaryngology and Communicative Disorders, The Long Island Jewish Medical Center, the Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA.
authors.forename: Dukhee
authors.initials: D
authors.lastname: Rhee
authors.forename: David
authors.initials: D
authors.lastname: Myssiorek
authors.forename: Gerald
authors.initials: G
authors.lastname: Zahtz
authors.forename: Alan
authors.initials: A
authors.lastname: Diamond
authors.forename: Carol
authors.initials: C
authors.lastname: Paley
authors.forename: Ashok
authors.initials: A
authors.lastname: Shende
mesh_terms: D002648:Child; D003937:Diagnosis, Differential; D018450:Disease Progression; D005158:Facial Paralysis / Q000175:diagnosis*; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010306:Parotid Gland / Q000503:physiopathology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000188:drug therapy; D012008:Recurrence