A 1-year-10-month-old child developed left-sided Ramsay Hunt syndrome (RHS) without vesicles 1 month after an episode of varicella zoster infection. No ear symptoms, including hearing loss, tinnitus, or imbalance, were reported. The external ear and otoscopic examinations were unremarkable. He achieved adequate recovery with corticosteroid treatment. This case report discusses the unusual presentation of RHS without vesicles, the diagnostic dilemma in young children, varicella zoster virus hepatitis, treatment modalities, and the role of vaccination in its prevention.
Varicella Zoster Virus Infection ; Herpes Zoster Oticus ; Zoster Sine Herpete ; Chickenpox Vaccine

Vestibular neuritis, one of common causes of acute spontaneous vertigo, is characterized by a sudden onset of vertigo with horizontal-torsional spontaneous nystagmus and unsteadiness with a falling tendency. Herpes zoster is a common infection caused by varicella-zoster virus (VZV), and herpes zoster ophthalmicus (HZO) occurs when this virus is reactivated in the ophthalmic branch of the trigeminal nerve. VZV can cause vestibular neuritis with cochlear dysfunction as a form of herpes zoster oticus, also known as Ramsay-Hunt syndrome. However, to our knowledge, isolated vestibular neuritis associated with HZO has been rarely reported, because of distance between the trigeminal nerve and the vestibulocochlear nerve. We present an unusual case of vestibular neuritis complicated by the HZO.
Dizziness ; Herpes Zoster ; Herpes Zoster Ophthalmicus ; Herpes Zoster Oticus ; Herpesvirus 3, Human ; Trigeminal Nerve ; Vertigo ; Vestibular Neuronitis ; Vestibulocochlear Nerve

No abstract available.
Herpes Zoster Oticus* ; Paralysis*

No abstract available.
Herpes Zoster Ophthalmicus* ; Herpes Zoster*

Primary clinical features of rash and neurological complications due to varicella zoster virus (VZV) reactivation are rare in a healthy population, especially in immunocompetent children. Early diagnosis and prompt treatment are delayed often due to their rarity. We present four immunocompetent children with VZV reactivation resulting in aseptic meningitis and herpes zoster affecting multiple cranial and spinal nerves. We reviewed the clinical manifestations, laboratory findings, treatment options and outcome of aseptic meningitis associated VZV reactivation. All patients presented with the typical skin lesion of VZV reactivation and definitive laboratory findings of central nervous system infection, without systemic inflammation. Initial manifestations of VZV reactivation included Ramsay Hunt syndrome, herpes zoster ophthalmicus, and herpes zoster affecting the left thoracic dermatomes 4–5. Intravenous acyclovir was administered and all patients recovered fully without any significant sequelae. VZV reactivation can lead to various neurological complications in immunocompetent children. Early recognition and treatment with acyclovir are important for improving the outcome of neurologic complications of VZV reactivation.
Acyclovir ; Central Nervous System Infections ; Chickenpox ; Child* ; Early Diagnosis ; Exanthema ; Herpes Zoster Ophthalmicus ; Herpes Zoster Oticus ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Inflammation ; Meningitis, Aseptic* ; Skin ; Spinal Nerves

BACKGROUND: Many studies about herpes zoster exist in the Korean dermatologic literature. However, few studies have reported about facial herpes zoster and its complications. OBJECTIVE: The purpose of this study was to investigate the epidemiology, clinical features, and complications of facial herpes zoster. METHODS: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. RESULTS: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. Results: The most common site of involvement of facial herpes zoster was the ophthalmic branch of the trigeminal nerve (59.2%). Herpes zoster involving the ophthalmic and the maxillary branches of the trigeminal nerves showed a significantly higher incidence rate of herpes zoster ophthalmicus than that observed with herpes zoster involving only the ophthalmic branch (odds ratio 7.373). Age and periorbital swelling were significantly correlated with herpes zoster ophthalmicus (p<0.001). Facial palsy was significantly correlated with otalgia and cutaneous ear involvement (p<0.001). Postherpetic neuralgia (PHN) occurred in 41% of patients with facial herpes zoster. Patients who received antiviral treatment within 3 days showed lower rates of PHN (35.8%) than patients who received treatment after 4 days (45.4%) (p=0.002). CONCLUSION: Facial herpes zoster is associated with several neurological complications. Variables including age, periorbital swelling, otalgia, and cutaneous ear involvement are useful predictors of complications and prognosis. Early institution of antiviral treatment and appropriate interdepartmental consultations are required for better treatment outcomes.
Ear ; Earache ; Epidemiology ; Facial Paralysis ; Herpes Zoster Ophthalmicus ; Herpes Zoster Oticus ; Herpes Zoster ; Humans ; Incidence ; Medical Records ; Neuralgia, Postherpetic ; Prognosis ; Referral and Consultation ; Retrospective Studies ; Trigeminal Nerve

Herpes zoster oticus usually accompanies vestibulopathy on the ipsilateral ear. However we have encountered two herpes zoster oticus patients with bilateral vestibulopathies. Bilateral vestibulopathy was detected on the 2nd month and 19th day of herpes zoster oticus, respectively. While the contralateral vestibulopathy was detected 2 month after the ipsilateral vestibulopathy in the first patient, the vestibular function deteriorated simultaneously on the 19th day in the second patient. It seems that the bilateral vestibulopathy was caused by an autoimmune process in both cases, but the initiating event is different. The ipsilateral vestibular damage may have sensitized the immune system in the first patient resulting in sympathetic vestibulopathy. But in the second patient, the ipsilateral cochlear damage may have sensitized the immune system resulting in simultaneous bilateral vestibulopathy.
Ear ; Herpes Zoster ; Herpes Zoster Oticus ; Humans ; Immune System

No abstract available.
Facial Nerve* ; Herpes Zoster Oticus* ; Herpes Zoster* ; Paralysis*

Ramsay Hunt syndrome (RHS) might cause serious complications, such as facial paralysis and hearing loss if diagnosis and treatments are delayed. Early diagnosis is therefore very important to avoid such serious complications. We report a case of RHS that was occurred during the treatment of postherpetic neuralgia resulted from zoster sine herpete. The patient showed severe segmental intercostal neuralgia at the right 11 and 12th thoracic level. There were no history of the trauma, operation and skin rash and vesicle on the lesion site. Varicellar-zoster virus (VZV) IgG Antibody was positive but VZV IgM antibody was negative. Pain nature was severe sharp, electrical shock like pain, but no paresthesia and dysesthesia was not existed. About two month later, small painful vesicular eruptions were occurred around the ipsilateral auricle. At this time, VZV IgM antibody was positive. Acyclovir, prednisolone, fexofenadine were immediately prescribed. The patient relieved from RHS without any complications. Clinician should be suspect the possibility of zoster sine herpete if the patient showed severe atypical chest wall pain.
Acyclovir ; Diagnosis ; Early Diagnosis ; Exanthema ; Facial Paralysis ; Hearing Loss ; Herpes Zoster Oticus* ; Herpes Zoster* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Neuralgia ; Neuralgia, Postherpetic ; Paresthesia ; Prednisolone ; Shock ; Thoracic Wall ; Zoster Sine Herpete*

No abstract available.
Herpes Zoster Ophthalmicus* ; Herpes Zoster* ; Ophthalmoplegia*