Three Cases of Lower Cranial Nerve Palsies Due to Reactivation of Varicella-Zoster Virus

Abstract

Varicella zoster virus (VZV) establishes latency in ganglionic neurons, and reactivation of VZV can produce a broad spectrum of neurological disorders involving these neurons, including lower cranial nerve palsies. It is rare for reactivation of VZV to manifest as lower cranial nerve palsies alone. We report three cases of VZV reactivation that presented with lower cranial nerve palsies. Case 1: A 52-year-old woman presented to our department with the complaints of right earache and dysphagia. Examination revealed no abnormal findings, except for right vocal cord palsy and oropharyngeal palsy. Cervicothoracic CT and head MRI did not show any abnormalities. Based on these findings and the results of blood tests, we suspected cranial nerve palsy due to reactivation of VZV and initiated the patient on antiviral drug and steroid treatment. Case 2: A 69-year-old woman visited our hospital with a 6-day history of pharyngeal pain and dysphagia. Laryngoscopy at another hospital revealed left vocal fold paralysis and saliva residue in the hypopharynx. As in Case 1, after closer examination, cranial nerve damage due to reactivation of VZV was suspected, and treatment was initiated. Case 3: An 82-year-old man presented with a 5-day history of throat pain and dysphagia. Based on the presence of a unilateral mucous membrane rash and severe pharyngeal pain, the patient was diagnosed as having pharyngolaryngitis caused by reactivation of VZV, and was started on antiviral medication. From the time of the initial examination, he had persistent hiccups and difficulty in sleeping. After treatment, the hiccups disappeared along with disappearance of the mucous membrane rash.