What happened, in summary

In April 2020, a 51-year-old woman developed soreness of the tongue followed by worsening pins and needles affecting the right lips, chin, and mouth. Dental and oral examinations did not identify a local cause. Neurologic assessment and MRI supported trigeminal neuralgia, and the unusual bilateral nerve changes prompted investigation for an underlying condition. PET-CT, MRI, and tissue testing ultimately identified stage 4 ovarian cancer. She had not experienced typical gynecologic symptoms and described being shocked that a tingling sensation in her mouth had led to the diagnosis.

She received 4 cycles of neoadjuvant carboplatin and paclitaxel, which she generally tolerated well. Delayed primary debulking surgery then achieved complete clearance of visible disease. She recovered well and completed 2 further cycles of adjuvant carboplatin and paclitaxel. Three months after surgery, she felt that she had responded well to chemotherapy and surgery. Anti-PARP maintenance treatment was planned but had not yet started.

The facial and oral nerve symptoms did not resolve with cancer treatment. Gabapentin and amitriptyline provided partial relief, and she continued daily pain medication with follow-up from neurology and rheumatology. A paraneoplastic neurologic syndrome was considered the most likely explanation, although a strongly positive Ro52 antibody left an inflammatory connective-tissue disorder as another possibility.