Ramsay Hunt Syndrome in 2 Patients With Acquired Immunodeficiency Syndrome

Abstract

Varicella zoster virus (VZV) is a herpes virus that can infect humans. After primary infection, it can reactivate with advancing age in immunocompetent hosts, causing the disease herpes zoster. It can occur earlier in life owing to decreased specific VZV humoral or cell-mediated immunity as seen in patients infected with the human immunodeficiency virus (HIV). Patients infected with HIV are at risk for severe illness either from primary VZV infection or reactivation. Herpes zoster may occur at any stage of HIV infection, and it is clinically recognizable by the presence of vesicles in a single dermatome, multiple contiguous dermatomes, or disseminated outside dermatomal pattern. Reactivation of VZV in the geniculate ganglion and seventh cranial nerve leads to Ramsay Hunt syndrome (RHS), which has been described in patients with HIV infection. We report 2 cases of VZV-associated RHS in HIV-infected patients. One patient had controlled HIV infection on antiretrovirals with undetectable HIV viral load, and the other patient had history of acquired immunodeficiency syndrome, very low CD4+ T-cell count, and prior use of steroids. Both developed seventh cranial nerve palsy and were treated with intravenous antiviral therapy and systemic steroids. Both patients have persistent facial asymmetry long after treatment for RHS. Our aim was to increase awareness of this rare syndrome in health care providers who care for individuals with HIV/acquired immunodeficiency syndrome.