A Suspected Atypical Case of Ramsay Hunt Syndrome Diagnosed in The Emergency Department

A Suspected Atypical Case of Ramsay Hunt Syndrome Diagnosed in The Emergency Department

Introduction: Ramsay Hunt syndrome is a rare complication of varicella zoster virus (VZV) reactivation, occurring in only approximately 0.2% of VZV reactivation cases. Despite its rarity, the morbidity associated with the syndrome is high, and the symptoms can be varied and nonspecific. Case Report: This report presents the case a 42-year-old female with an atypical presentation of Ramsay Hunt syndrome. Initially, her symptoms were concerning with regard to stroke; however, stroke workup was normal, and the consultants considered her symptoms to be the most consistent with Ramsay Hunt syndrome. Conclusion: The classical symptoms of Ramsay Hunt syndrome include otalgia; a vesicular rash in either the auditory canal, hard palate, or anterior two-third of the tongue; and ipsilateral facial paralysis or weakness. Our literature review revealed that there were no similar case reports; however, all emergency physicians should include this syndrome as part of the differential diagnosis of patients who present with unilateral paralysis

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  • Worme M, Reena Chada R, Lavallee L. An unexpected case of Ramsay hunt syndrome: case report and literature review. BMC Res Notes 2013; 6: 337. [CrossRef]
  • Ferri FF. Herpes Zoster. Ferri’s Clinical Advisor 2017; 587-96.
  • Bharadwaj S, Moffat AC, Wood B, Bharadwaj A. Herpetic cranial poly- neuritis mimicking brain stem infarction-an atypical presentation of Ramsay Hunt syndrome. BMJ Case Rep 2016. [CrossRef]
  • Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry 2001; 71: 149-54. [CrossRef]
  • Gupta NM, Parikh MP, Panginikkod S, Gopalakrishnan V. Ramsay Hunt Syndrome. QJM 2016; 109: 693. [CrossRef]
  • Volpi A. Severe Complications of Herpes Zoster. Herpes 2007; 14: 35-9.
  • Murakami S, Hato N, Horiuchi J Honda N, Gyo K, Yanagihara N. Treat- ment of Ramsay Hunt Syndrome with Acyclovir-Prednisone: Aignifi- cance of Early Diagnosis and Treatment. Ann Neurol 1997; 41: 353-7. [CrossRef]
  • Chan TL, Cartagena AM, Bombassaro AM, Hosseini-Moghaddam SM. Ramsay Hunt Syndrome Associated with Central Nervous System In- volvement in an Adult. Can J Infect Dis Med Microbiol 2016. [CrossRef]
  • Kayayurt K, Yavasi O, Bilir O. Ersunan G, Giakoup B. A Case of Ramsay Hunt Syndrome with Atypical Presentation. Turk J Emerg Med 2016; 14: 142-5. [CrossRef]