An Atypical Ramsay-Hunt Syndrome: Case Report

Abstract

After the initial infection, which manifests as varicella, the varicella-zoster virus (VZV) remains dormant in the sensory nerve ganglia. It reactivates in elderly people or in immunocompromised patients. When this reactivation involves the geniculate ganglion, it typically causes the Ramsay-Hunt syndrome manifesting as shingles in the Hunt’s zone which includes the eardrum, the external auditory canal and the cavum conchae, as well as a peripheral facial nerve palsy, earache and sensitivity or sensorial disturbances of the nearby cranial ans spinal nerves. Our case describes a 40-year-old patient who developed an atypical Ramsay-Hunt syndrome associating only peripheral facial nerve paralysis and a herpetiform vesiculopustular rash in the retroauricular area, with no otologic, vestibular or sensory signs. In fact, there are anastomoses between the different cranial nerve fibers and ganglia with the spinal nerves and ganglia, which may explain the occurrence of herpes zoster in the C2 dermatome with peripheral facial nerve palsy.