Ramsay-Hunt syndrome in a 4-year-old child

Ramsay Hunt syndrome in a girl with acute lymphoblastic leukemia during maintenance therapy

A 5-year-old girl with precursor B-cell acute lymphoblastic leukemia developed peripheral-type right facial palsy and very faint erythema on her right pinna during maintenance therapy. Acyclovir was started for possible zoster infection. The following day, vesicles appeared and a diagnosis of Ramsay Hunt syndrome was made. Prednisolone was started on day 5 after onset. Her facial palsy recovered within 6 months. Ramsay Hunt syndrome is a rare cause of facial palsy in patients with acute lymphoblastic leukemia, and this is the first case report. Preemptive therapy with acyclovir before the development of vesicles should help the patient recover from facial palsy.

Herpes zoster oticus (Ramsay Hunt syndrome) in children: case report and literature review

INTRODUCTION

Approximately 10% of patients with peripheral facial nerve palsy are children. Facial nerve palsy is usually idiopathic. An uncommon cause is herpes zoster oticus (Ramsay Hunt syndrome). This syndrome usually affects adults and is rare in children.

METHODS

We reviewed the literature and describe the cause, clinical manifestations, and treatment of Ramsay Hunt syndrome. We also report a case of the syndrome in a 12-year-old boy.

CONCLUSION

Ramsay Hunt syndrome is characterized by peripheral facial paralysis associated with herpetic eruption on the auricula and external ear, and by vestibulocochlear dysfunction. It occurs by reactivation of latent varicella-zoster virus (VZV) in the geniculate ganglion, affecting the seventh and eighth cranial nerves. The diagnosis is based on history and physical findings. Treatment of Ramsay Hunt syndrome uses a combination of high-dose corticosteroids and acyclovir. Although the prognosis is better in children than in adults, it is not good enough.

Ramsay Hunt syndrome in a 3-month-old infant

Ramsay Hunt syndrome is a disorder characterized by herpetic eruptions on the auricle, facial paralysis, and vestibulocochlear dysfunction, and is attributed to varicella zoster virus infection in the geniculate ganglion. Although it is a common cause of acute peripheral facial paralysis, children are not usually affected. We describe Ramsay Hunt syndrome in a 3-month-old infant who was referred because of a 2-day-old appearance of herpetic blisters on the right auricle and along the distribution of the right facial nerve. His mother had been infected with chickenpox during the second trimester of pregnancy. The infant presented with right facial palsy and was anxious, but had no fever. Otoscopy revealed herpetic eruptions in the right ear canal. Otoacoustic emissions were absent in the right ear and auditory brainstem responses confirmed moderate sensorineural hearing loss. Appropriate treatment resulted in slight improvement after the first week and complete recovery within 4 months. Infection with varicella zoster virus was proved by a significant increase in the serum anti-varicella zoster virus antibody titer during the convalescent phase of the disease.