BACKGROUND: Melkersson-Rosenthal syndrome (MRS) is a rare disorder of unknown 
etiology characterized by a triad of symptoms: recurrent orofacial swelling, 
relapsing facial palsy. and a fissured tongue. A differential diagnosis must be 
made with other granulomatous diseases, such as sarcoidosis and oral Crohn 
disease; however, the histologic findings of noncaseating, sarcoidal granulomas 
support the diagnosis of MRS.
RESULTS: Many therapeutic modalities have been described for this disease. In 
this case report, we present a patient with MRS that was treated with 
thalidomide because of the identification of tumor necrosis factor a in the 
lesion by immunohistochemical analysis. This is the first reported detection of 
tumor necrosis factor a in an MRS lesion, as well the first reported use of 
thalidomide to treat this clinical condition.