Ramsay Hunt Syndrome in a Patient with Ulcerative Colitis Treated with Infliximab

Herpes zoster-encefalitis: een diagnostische uitdaging bij de geriatrische patiënt

Tijdschrift voor Geneeskunde ◽

10.47671/tvg.77.21.190 ◽

2022 ◽

Author(s):

L. Carmans ◽

C. Van Dessel

Keyword(s):

Herpes Zoster ◽

Rare Complication ◽

Diagnostic Process ◽

Herpes Encephalitis ◽

Diagnostic Challenge ◽

Varicella Zoster ◽

Ramsay Hunt Syndrome ◽

Hunt Syndrome ◽

Prevalent Disease ◽

Vesicular Rash

Herpes zoster encephalitis: a diagnostic challenge in a geriatric patient Reactivation of the varicella zoster virus (VZV) is a prevalent disease and is - in addition to the typical vesicular rash - responsible for rare neurological conditions. Older people form a major group of concern, given the increasing risk of VZV reactivation at a higher age together with a higher risk of complications. Herpes zoster encephalitis is a rare but serious complication which often presents atypically, delaying the diagnostic process. In this article, the medical history of a patient with herpes encephalitis without the typical clinical and biochemical signs of infection is presented. This patient also suffered from Ramsay Hunt syndrome, another rare complication of VZV, characterized by vesicular rash in the ear and ipsilateral peripheral facial paralysis. Both diseases are briefly reviewed and the potential benefits of vaccination are discussed.

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Ramsay hunt syndrome- expect the unexpected: A case report

Journal of Oral Medicine Oral Surgery Oral Pathology and Oral Radiology ◽

10.18231/j.ijooo.2021.052 ◽

2021 ◽

Vol 7 (3) ◽

pp. 172-175

Author(s):

Poorva Saxena ◽

G. V. Ramachandra Reddy ◽

Hina Handa ◽

Ajita Singh

Keyword(s):

Case Report ◽

Herpes Zoster ◽

Neurological Diseases ◽

Rare Complication ◽

Varicella Zoster Virus Infection ◽

Post Herpetic Neuralgia ◽

Varicella Zoster ◽

Ramsay Hunt Syndrome ◽

Hunt Syndrome ◽

Vesicular Rash

Herpes zoster represents a latent reactivation of the varicella zoster virus infection with a dermatomal pattern of eruption and complicated by post-herpetic neuralgia. Ramsay hunt syndrome is a rare complication of herpes zoster and it is not just a syndrome but it's rather an infectious disease. This syndrome is characterized by peripheral facial nerve palsy associated with an erythematous vesicular rash on the ear. It is characterized by unilateral pattern of facial involvement and presence of vesicles helps in early diagnosis and distinguish the syndrome with diseases mimicking other severe neurological diseases. This article reports a case of 56-year-old male patient who reported with a complaint of severe toothache, which serves as severe prodrome for reactivation of herpes zoster virus which later leads to Ramsay Hunt syndrome. This case report highlights about the management of herpes zoster and its complication and emphasizes on prevention of post herpetic neuralgia complication.

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Facial paralysis due to Ramsay Hunt syndrome - A rare condition

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.63.04.301 ◽

2017 ◽

Vol 63 (4) ◽

pp. 301-302 ◽

Cited By ~ 2

Author(s):

Aline Lariessy Campos Paiva ◽

João Luiz Vitorino Araujo ◽

Vinicius Ricieri Ferraz ◽

José Carlos Esteves Veiga

Keyword(s):

Herpes Zoster ◽

Facial Paralysis ◽

Rare Complication ◽

Rare Condition ◽

Varicella Zoster Virus Infection ◽

Varicella Zoster ◽

Ramsay Hunt Syndrome ◽

Hunt Syndrome ◽

Condition Diagnosis ◽

Symptoms And Signs

Summary Ramsay Hunt syndrome (or herpes zoster oticus) is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection in the geniculate ganglion occurs. Usually, there are auricular vesicles and symptoms and signs such otalgia and peripheral facial paralysis. In addition, rarely, a rash around the mouth can be seen. Immunodeficient patients are more susceptible to this condition. Diagnosis is essentially based on symptoms. We report the case of a diabetic female patient who sought the emergency department with a complaint of this rare entity.

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Brainstem and Cerebellar Involvement in Ramsay Hunt Syndrome

Case Reports in Otolaryngology ◽

10.1155/2019/7605056 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Vijay Letchuman ◽

Charles D. Donohoe

Keyword(s):

Varicella Zoster Virus ◽

Facial Paralysis ◽

Cerebral Peduncle ◽

Geniculate Ganglion ◽

Abducens Nucleus ◽

Varicella Zoster ◽

Ramsay Hunt Syndrome ◽

Hunt Syndrome ◽

Intravenous Acyclovir ◽

Clinical Awareness

We present a case of a 62-year-old Caucasian male with laryngeal cancer and Ramsay Hunt Syndrome otherwise known as herpes zoster oticus due to reactivation of the varicella zoster virus. Classic findings include the triad of ipsilateral facial paralysis, otic pain, and herpetic lesions in the sensory supply of the facial nerve. The common pathogenesis is associated with anterograde axonal reactivation of the varicella zoster virus in the geniculate ganglion. Unique features of our case include retrograde transaxonal spread of the varicella-zoster virus from the geniculate ganglion into the brainstem and cerebellum including involvement of the abducens nucleus, facial nucleus, middle cerebral peduncle, and inferior cerebellar peduncle. This presented as left facial paralysis, left sixth nerve palsy, horizontal diplopia to the left lateral gaze, profound truncal ataxia, and left-sided dysmetria. Clinical awareness that Ramsay Hunt syndrome may also involve the brainstem and cerebellum is critical in evaluating the clinical neurologic findings and expanding the diagnostic workup to include brain magnetic resonance imaging and cerebrospinal fluid analysis, including varicella zoster polymerase chain reaction. Encephalitis requires longer duration administration of high-dose intravenous acyclovir in conjunction with steroids. Delays in treatment are often associated with unsatisfactory outcomes with extensive residual deficits.

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Ramsay hunt syndrome- expect the unexpected: A case report

Journal of Oral Medicine Oral Surgery Oral Pathology and Oral Radiology ◽

10.18231/j.jooo.2021.052 ◽

2021 ◽

Vol 7 (3) ◽

pp. 172-175

Author(s):

Poorva Saxena ◽

G. V. Ramachandra Reddy ◽

Hina Handa ◽

Ajita Singh

Keyword(s):

Case Report ◽

Herpes Zoster ◽

Neurological Diseases ◽

Rare Complication ◽

Varicella Zoster Virus Infection ◽

Post Herpetic Neuralgia ◽

Varicella Zoster ◽

Ramsay Hunt Syndrome ◽

Hunt Syndrome ◽

Vesicular Rash

Herpes zoster represents a latent reactivation of the varicella zoster virus infection with a dermatomal pattern of eruption and complicated by post-herpetic neuralgia. Ramsay hunt syndrome is a rare complication of herpes zoster and it is not just a syndrome but it's rather an infectious disease. This syndrome is characterized by peripheral facial nerve palsy associated with an erythematous vesicular rash on the ear. It is characterized by unilateral pattern of facial involvement and presence of vesicles helps in early diagnosis and distinguish the syndrome with diseases mimicking other severe neurological diseases. This article reports a case of 56-year-old male patient who reported with a complaint of severe toothache, which serves as severe prodrome for reactivation of herpes zoster virus which later leads to Ramsay Hunt syndrome. This case report highlights about the management of herpes zoster and its complication and emphasizes on prevention of post herpetic neuralgia complication.

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Herpes Zoster Otikus Dengan Paresis Nervus Fasialis (Sindrom Ramsay Hunt) Pada Pasien Imunokompromais

Medica Hospitalia : Journal of Clinical Medicine ◽

10.36408/mhjcm.v7i1.437 ◽

2020 ◽

Vol 7 (1) ◽

pp. 113-118

Author(s):

Holy Ametati ◽

Hayra Diah Avianggi

Keyword(s):

Herpes Zoster ◽

Facial Nerve ◽

Rare Complication ◽

Left Chest ◽

Varicella Zoster ◽

Ramsay Hunt Syndrome ◽

Herpes Zoster Oticus ◽

Hunt Syndrome ◽

Zoster Sine Herpete ◽

Nerve Paresis

Latar belakang: Sindrom Ramsay Hunt (SRH) merupakan komplikasi yang jarang terjadi pada herpes zoster. SRH dapat terjadi tanpa adanya ruam kulit (zoster sine herpete). Karena gejala-gejala ini tidak selalu muncul saat onset, sindrom ini sering salah didiagnosis. Insidensi 5/100.000 kasus pada populasi di Amerika Serikat dan meningkat pada kelompok umur di atas 60 tahun dan kondisi imunokompromais. Laporan Kasus: Laki-laki, 66 tahun, timbul plenting-plenting di daerah telinga kiri menyebar ke dada sebelah kiri sejak 8 hari sebelum dikonsulkan. Terdapat nyeri pada telinga, pendengaran berkurang, pusing berputar, wajah sebelah kiri sulit digerakkan dan sulit berbicara. Permeriksaan fisik ditemukan vesikel berkelompok dengan dasar kulit eritem dan edema, bula, erosi, krusta, konfigurasi herpetiformis, distribusi unilateral, segmental setinggi persarafan servikal 2-4. Temuan tzank test menunjukkan sel datia berinti banyak. Penatalaksanaan dengan sistemik asiklovir dan metilprednison. Pembahasan: SRH merupakan hasil reaktivasi virus varicella zoster laten diganglion genikulatum yang menyebabkan vesikel pada aurikula, otalgia dan paresis/paralisis fasialis. Mekanisme pencetus reaktivasi pada pasien ini diduga berhubungan dengan imunokompromais (keganasan). Pasien imunokompromais memiliki resiko 20-100 kali lebih besar. Pemeriksaan Tzank sesuai dengan gambaran herpes zoster. Terapi SRH yang paling disarankan adalah terapi kombinasi antivirus dan kortikosteroid. Kesimpulan: Telah dilaporkan kasus herpes zoster otikus dengan paresis nervus fasialis (Sindrom Ramsay Hunt) pada pasien imunokompromais. Hasil terapi memuaskan. Prognosis qua ad vitam ad bonam, ad sanam dubia ad malam, ad cosmeticam dubia ad bonam. Kata kunci: Sindrom Ramsay Hunt, Herpes Zoster Otikus, Paresis Nervus Fasialis, Immunokopromais. Background; Ramsay Hunt Syndrome (RHS) is a rare complication in shingles. RHS can occur without the presence of skin rash (zoster sine herpete). Because these symptoms do not always appear at onset, RHS is often misdiagnosed. The incidence of 5/100,000 cases in the US and increase in the age above 60 years and immunocompromised. Case: A 66-years-old male complaint of vesicle on the left ear spreading to left chest, since 8 days prior to the consultation. There was otalgia, dizziness, hearing impairment, difficulty in movement and speaking on the left side. Physical examination found clustered vesicle on an erythematosus and oedematous base, bullaes, erosions, crusts, in a herpetiformis configuration, unilateral distribution, in a level of 2-4 cervical nerve innervation. The Tzank test showed multinucleated giant cells. Management with systemic acyclovir and methylprednisolone. Discussion: RHS is the result of reactivation of latent varicella zoster virus in geniculate ganglion which causes vesicles in the auricle, otalgia and facial paresis / paralysis. The mechanism for triggering reactivation in these patients is immunocompromise (malignancy). Immunocompromised have a 20-100 times greater risk. Tzank results in accordance with diagnostic of herpes zoster. The most recommended therapy is combination of antiviral and corticosteroid. Conclusion: The case of herpes zoster oticus with facial nerve paresis (Ramsay Hunt Syndrome) in immunocompromised has been published. The result of therapy was satisfying. The prognosis qua ad vitam ad bonam, ad sanam dubia ad malam, ad cosmetics dubia ad bonam. Keywords: Ramsay Hunt Syndrome, Herpes Zoster Oticus, Facial Nerve Paresis, Immunokopromised.

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