Abstract
BackgroundHerpes zoster oticus accounts for about 10% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients. Bilateral herpes zoster oticus can sometime occur in immunocompromised patients, though incidence is very rare.Case presentationDiabetic male, 57 year old presented to us with bilateral facial palsy due to herpes zoster oticus. Patient was having bilateral mild to moderate sensorineural hearing loss. Patient was treated with appropriate metabolic control, anti-inflammatory drugs and intravenous acyclovir. Due to uncontrolled diabetes, glucocorticoids were not used in this patient. Significant improvement in hearing status and facial nerve functions were seen in this patient.ConclusionsHerpes zoster causes severe infections in diabetic patients and can be a cause of bilateral facial palsy and bilateral Ramsay Hunt syndrome. Herpes zoster in diabetic patients should be treated with appropriate metabolic control, NSAIDS and intravenous acyclovir, which we feel should be started at the earliest. Glucocorticoids should be avoided in diabetic patients.
Highlights
Herpes zoster oticus accounts for about 10% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients
Herpes zoster in diabetic patients should be treated with appropriate metabolic control, NSAIDS and intravenous acyclovir, which we feel should be started at the earliest
-Herpes zoster in diabetic patients should be treated with appropriate metabolic control, NSAIDS and intravenous acyclovir, which we feel should be started at the earliest
Summary
Herpes zoster can cause severe infections in diabetic patient and can cause bilateral facial palsy and bilateral Ramsay Hunt syndrome. Hiroshige K et al (2002) conducted a study based on detection of varicella zoster virus DNA in tear fluid and saliva of patients with Ramsay Hunt syndrome and concluded that varicella zoster virus reactivation occurs in the unaffected side at the same level as in the affected side [7]. This explains the occurrence of bilateral Ramsay Hunt syndrome due to herpes zoster oticus in this patient. -Intravenous acyclovir therapy in cases of herpes zoster oticus is effective in control of disease and prevents the incidence of permanent facial palsy but treatment should be started early in the course of disease preferably with in 72 hrs from start of disease. -Glucocorticoids should be avoided in Herpes zoster patients having uncontrolled diabetes
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