SICKLE CELL CRISIS PRESENTING AS A NUMB CHIN SYNDROME IN A CHILD

Objectives: Numb chin syndrome, also called mental neuropathy, is usually conceived of as a harbinger of malignancy of the skull. We describe an unusual presentation of a case of a numb chin syndrome in a child with sickle cell crisis involving her mandible.

Methods: Case report.

Results: The patient is 6 year-old girl with known sickle cell disease and auto-immune hepatitis of unclear etiology. She was seen by the neurology service for acute onset of a numb chin in context of a painful jaw. Examination revealed painful swelling at the level of the mandible bilaterally as well as sensory deficits in the distribution of the mental nerve, involving the lower lip and chin bilaterally. Taste and tongue sensation were preserved. MRI of the jaw showed a right temporal mandibular joint effusion and abnormal marrow signal suggestive of vascular necrosis. Symptoms completely resolved after one week with symptomatic treatment of the sickle cell crisis. This patient is now followed for a steroid myopathy.

Conclusion: Sickle cell crisis should be included in the differential diagnosis of numb chin syndrome in children. Magnetic Resonance Imaging is useful in identifying the underlying etiology.