Ramsay Hunt syndrome: a rare complication of herpes zoster infection in a lung cancer patient

ABSTRACT

Objectives: Ramsay Hunt syndrome (RHS) is a rare complication of varicella zoster virus (VZV) reactivation with high morbidity, requiring swift and specific treatment.

Methods: We discuss the epidemiology, diagnosis and treatment of RHS using a case report of a cancer patient who presented with disseminated VZV reactivation, including RHS.

Results: A 68-year old man with stage IV lung adenocarcinoma, for which he received pemetrexed maintenance chemotherapy, presented to the emergency department with a progressive skin rash despite broad spectrum antibiotics, vertigo, and diminished hearing. Valacyclovir was started for a varicella zoster virus (VZV) reactivation. Despite antiviral therapy, his symptoms progressed with late appearance of vesicles in the external ear canal, leading to a diagnosis of Ramsay Hunt syndrome (RHS).

Conclusion: RHS is a rare complication of VZV reactivation and can lead to peripheral facial nerve palsy, hearing loss, vestibular problems, and vesicles in the dermatome of the cranial nerve. Timely initiation of steroids and antiviral therapy lead to recovery of the facial nerve in >75% of cases, although the optimal therapy is still unclear.

KEYWORDS:

• Herpes zoster oticus
• Ramsay Hunt syndrome
• facial nerve
• vestibulocochlear nerve
• pemetrexed

Acknowledgements

The authors wish to thank the patient for his willingness to provide us with his explicit and written permission to use photographic documentation of his clinical presentation for this article.

Disclosure statement

No potential conflict of interest was reported by the authors.