Bilateral Facial Nerve Palsy Associated with p-ANCA Positive Vasculitis in a Patient with Rheumatoid Arthritis

This document described a case of a 67-year-old woman with rheumatoid arthritis who developed bilateral facial nerve palsy associated with p-ANCA positive vasculitis. Initially, she presented with left-sided facial weakness, diagnosed as left Bell's palsy, and was already on medication for rheumatoid arthritis, hypothyroidism, and other conditions. A week later, she developed right-sided facial weakness without improvement on the left side, leading to bilateral facial nerve involvement. This case highlighted the rare occurrence of central and peripheral nervous system involvement in rheumatoid arthritis, particularly in association with p-ANCA positive vasculitis.