Varicella zoster virus (VZV) is a widespread human herpesvirus which causes chickenpox (varicella). VZV infection can produce a broad spectrum of neurologic disorders including multiple cranial nerve palsies. Among the cranial nerves, trigeminal and facial nerves are the most commonly involved. However, multiple lower cranial nerve palsies caused by VZV infection is very rare. It is a diagnostic dilemma for VZV infection if there are no skin or mucosa lesions, which are characteristic signs of VZV infection. We report the case of a 54-year-old man with sudden right hearing loss, sore throat, odynophagia, hoarseness, dysphagia and vertigo. Pure tone audiometry revealed right sensorineural hearing loss and laryngoscopy proved that there were paralyses of the right upper pharyngeal constrictor muscle and vocal cord. These findings were consistent with acute unilateral vestibulocochlear, glossopharyngeal and vagus nerve palsies. There were no skin or mucosa lesions noted in our patient. The diagnosis was assisted by the existence of anti-VZV serum IgM even if the polymerase chain reaction result was negative. The symptoms of the patient improved after receiving anti-viral therapy. We emphasize the role of VZV infection in multiple cranial nerve palsies and the importance of serologic test.
Herpesvirus 3, Human ; Cranial Nerve Diseases