Abstract
Patient: The patient is a 31-year-old female. She had been suffering from burning pain and numbness on the left side of her lower lip and jaw for 2 months. She visited otolaryngology, cerebrovascular medicine, and oral surgery, although the primary disease was not defined and the symptoms did not improve, therefore she was referred to our department. Since the third branch of the left trigeminal nerve region showed pain and sensory disturbance, we started oral administration of VB12, adenosine triphosphate, and mirogabalin, in addition once a week stellate ganglion block treatment. 1 month after the start of treatment, pain and sensory disturbance in the trigeminal region were generally improved, but 4 months after the start of treatment, pain worsened and sensory disturbance spread to all branches of the trigeminal nerve bilaterally. Furthermore, she complained of stiff fingers and pallor of hands in cold environment, which appeared to be Raynaud’s phenomenon, therefore we referred her to rheumatology department. She was diagnosed with mixed connective tissue disease （MCTD） of more than moderate severity, and treatment was initiated. Currently, Raynaud’s phenomenon, arthralgia, and pain in the trigeminal nerve region has improved, but sensory disturbance has remained.
Discussion: Trigeminal neuropathy and trigeminal neuralgia are among the symptoms of MCTD, but there are only a few reports in which these symptoms appeared isolated as initial manifestation prior to frequent symptoms such as Raynaud’s phenomenon, therefore, we had difficulty in diagnosing the primary disease.
Conclusion: MCTD should be considered as a differential diagnosis for pain and sensory disturbances in the trigeminal region.
