MRCP2-3132

MRCP2-3132

A 48-year-old man presents with bilateral facial weakness and diplopia that has been worsening over the past five days. He is unable to fully close his eyes, which are becoming red and dry. He denies any recent infections or headaches and has not experienced any weakness or numbness in his limbs or difficulty breathing. His medical history includes left uveitis, which was treated with topical steroids when he was 18 years old. He is a non-smoker, drinks 24 units of alcohol per week, and is not taking any regular medication. On examination, there is a painful circular nodular lesion over his left shin, and he has marked bilateral lower motor neuron facial weakness with an additional right VI nerve palsy. A CT scan of the brain is normal, but a lumbar puncture reveals an opening pressure of 16 cmH2O, CSF protein of 1.5 g/L (0.15-0.45), CSF white cell count of 125 cells per ml (≤5), CSF white cell differential of 90% lymphocytes, CSF red cell count of 4 cells per ml (≤5), CSF glucose of 3.5 mmol/L (3.3-4.4), and positive CSF oligoclonal bands. What is the most likely diagnosis for this patient?