Ramsay Hunt syndrome

Etiology and Management of 800 Patients With Facial Palsy at a Private Practice Setting Over a 5-Year Period

INTRODUCTION

Very few papers investigated the etiologic breakdown and demographic characteristics of patients with facial nerve (FN) palsy. Our paper aims to present the etiologic breakdown and demographic characteristics of patients with FN palsy, presenting at a private care center between 2014 and 2019, along with the treatment modalities that were offered to them.

METHODS

Charts of 800 patients with facial palsy (FP) were reviewed. Data included the etiology of their diagnosis, family history, recurrent FP, demographic information, and treatment provided before and after presentation.

RESULTS

Seventy-five percent of our study population were females. The average period between diagnosis with FP and presentation at our center was 10.8 years. The most commonly identified etiology was Bell's palsy, followed by acoustic neuroma. Eighty-one percent of the study subjects were prescribed steroids and/or antivirals. Facial neuromuscular retraining, electrical stimulation, chemodenervation, and surgical intervention were also part of some treatment plans for our population.

DISCUSSION

Recommendations for the treatment of idiopathic FP include steroids with adjuvant antiviral medications. Data remains uncertain whether the combination therapy of steroids and antivirals has better results compared to steroids alone. Electrical stimulation is still a controversial therapeutic tool for facial paralysis with a potential role in exacerbating synkinesis. The difference in referral patterns between tertiary and private care centers can explain the disparity in the ranking of the etiologies between our study and what has been published.

CONCLUSION

Management of FP is a complex process. The FN community must develop a common database to improve its understanding of the different presentations.

Imaging of Pathologies of the Temporal Bone and Middle Ear: Inflammatory Diseases, Their Mimics and Potential Complications-Pictorial Review

Imaging of the temporal bone and middle ear is challenging for radiologists due to the abundance of distinct anatomical structures and the plethora of possible pathologies. The basis for a precise diagnosis is knowledge of the underlying anatomy as well as the clinical presentation and the individual patient's otological status. In this article, we aimed to summarize the most common inflammatory lesions of the temporal bone and middle ear, describe their specific imaging characteristics, and highlight their differential diagnoses. First, we introduce anatomical and imaging fundamentals. Additionally, a point-to-point comparison of the radiological and histological features of the wide spectrum of inflammatory diseases of the temporal bone and middle ear in context with a review of the current literature and current trends is given.

Frequency-dependent hearing outcomes with or without preservation of intact ossicular articulations

Objective

To determine the frequency-specific benefits of ossicular chain preservation compared to performing disarticulations and reconstructions in transmastoid facial nerve decompression surgery in patients with an intact ossicular chain.

Methods

A retrospective chart review (January 2007 and June 2018) of patients undergoing transmastoid facial nerve decompression on the intact middle ear for severe facial palsy at a tertiary referral center. Surgery was performed with ossicular chain disarticulation on an as-needed basis using either ossicular chain preservation (without ossicular disarticulation), incudostapedial separation, or incus disarticulation technique. Hearing outcomes were assessed.

Results

The 108 patients were included in this study. Among these, 89 patients underwent ossicular chain preservation, 5 underwent incudostapedial separation and 14 underwent incus repositioning. The proportion of patients with a change in the 4-frequency air conduction pure-tone average of less than 10 dB was 91%, 60%, and 50%, respectively, for the three surgical techniques; these were significantly different (Fisher's exact test, p < .001). Frequency-specific analysis showed that air conduction was significantly better following the ossicular chain preservation technique compared with the incus repositioning technique at stimulation frequencies lower than 250 Hz and higher than 2000 Hz, and compared with the incudostapedial separation technique at 4000 Hz. Analysis of biometric measures determined on CT images suggested that the feasibility of the ossicular chain preservation technique correlates with incus body thickness on coronal CT images.

Conclusions

Ossicular chain preservation is an effective approach for hearing preservation in transmastoid facial nerve decompression or similar surgical procedures.

Fear of falling as a potential complication of Ramsay Hunt syndrome in older adults: a case report

BACKGROUND

Fear of falling (FOF) is a common and major health concern in older adults. The consequences of FOF include reduced physical performance, social activity, and health-related quality of life. Ramsay Hunt syndrome (RHS) is a herpes zoster-related facial nerve dysfunction accompanied by an erythematous vesicular rash on the ear or mouth that may complicate ipsilateral facial paralysis and otalgia, vertigo, tinnitus, hearing loss, and meningoencephalitis. However, repeated falls and subsequent FOF due to RHS have not been reported in older adults.

CASE PRESENTATION

A 65-year-old woman diagnosed with RHS experienced repeated falls during hospital admission and after discharge. Despite recovery of balance and no subsequent falls, the patient presented with persistent FOF at the geriatric outpatient follow-up visit 1 year after the RHS episode. The fear sensation impaired the patient's instrumental daily activities and was confirmed by documentation of serial comprehensive geriatric assessments, especially the Timed Up and Go test scores.

CONCLUSIONS

RHS may cause repeated falls and FOF, leading to impairment in daily activities and psychosocial function in older adults. Therefore, clinicians should be mindful of falls and FOF when caring for older patients with RHS and should develop multidimensional strategies for fall prevention and FOF.

Benefits of High-Dose Corticosteroid and Antiviral Agent Combination Therapy in the Treatment of House-Brackman Grade VI Ramsay Hunt Syndrome

OBJECTIVE

Few large-scale investigations have been conducted on treatment of House-Brackmann grade VI (HB grade VI) Ramsay Hunt syndrome (RHS) patients. We compared recovery rates among patients receiving a normal-dose corticosteroid (prednisolone [PSL] 60 mg/d) or high-dose corticosteroid (PSL 200 mg/d), both with or without an antiviral agents. Recovery rates were also examined based on the order of presentation of herpetic vesicles versus facial palsy.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary referral center.

PATIENTS

A total of 128 patients with HB grade VI RHS were treated in our department between 1995 and 2017. These patients were divided into four treatment groups based on corticosteroid dosage and use of an antiviral agent.

METHODS

We assessed treatment outcomes for HB grade VI patients together with logistic regression analysis to investigate factors that can impact treatment outcomes, that is, sex, age, days to start of treatment, PSL dosage, and antiviral agent administration.

RESULTS

Recovery rates were best in the high-dose corticosteroid group with an antiviral agent (71.1%) in comparison with the normal-dose corticosteroid group with an antiviral agent (60.0%) or high-dose corticosteroid alone (57.1%). Significant factors for treatment outcomes were high-dose corticosteroid administration and early initiation of treatment. A better recovery rate was also found when the herpetic vesicles appeared before facial palsy.

CONCLUSION

We showed that a combination of a high-dose corticosteroid and antiviral agent produced the best outcomes for patients with HB grade VI RHS. However, our results were not statistically significant because of small sample size.

Herpes zoster of orofacial region

Herpes zoster (HZ) is a viral disease which is primarily caused by the nerve tissue, but its treatment necessitates a multidisciplinary approach. Varicella zoster virus (VZV) is a DNA virus that causes both primary and recurrent infection. HZ, also known as shingles, is a unique condition induced by VZV reactivation. Neuropathic pain, headache, malaise and sleep disruption are all prodromal symptoms in such cases. HZ generates a pruritic, localized and vesicular rash that is usually unilateral. Individuals who are immunocompromised as a result of disease or receiving any treatment are also at increased risk, regardless of their age. HZ and its sequelae set a major strain on patient's caregivers, health-care system and business. Despite recent advances, prevention and treatment of HZ, consequences remain a therapeutic challenge. This is a case report of HZ infection in a 56-year-old female patient who was managed with comprehensive medical treatment.

[Ramsay Hunt syndrome]

Ramsay Hunt syndrome is a complication of varicella-zoster virus infection, which manifests by geniculate ganglion involvement. Clinical presentation of Ramsay Hunt syndrome includes virus affecting external ear by vesicular rash on the ear, ear pain and peripheral facial nerve paralysis. The review presents an analysis of etiology, clinical picture and diagnosis of the disease. The clinical features of combined cranial nerve involvement, contemporary treatment and prophylaxis options are described. Early diagnosis and medical therapy is a crucial factor for positive prognosis to improve damaged nerves in Ramsay Hunt syndrome.

Cranial polyneuropathy caused by herpes zoster infection: a retrospective single-center analysis

PURPOSE

Cranial polyneuropathy (CP) is a rare complication of herpes zoster (HZ) infection. This entity often produces situations of a diagnostic dilemma, as can be seen in a wide spectrum of clinical presentations. The aim of this study was to report the clinical characteristics, treatment, and outcomes of 11 patients from a single-institution experience.

METHODS

A retrospective analysis of patients treated for HZ CP over a 12-year period was performed.

RESULTS

The present study included 11 patients with CP caused by HZ infection-7 (63.63%) females, and 4 (36.36%) males. The mean age at presentation was 63 years (range, 38-85 years). Cranial nerve VII was affected in nine (81.82%) cases, CN VIII in six (54.55%) cases, CN V in five (45.45%) cases, CN III and IX in two (18.18%) cases, and CN VI and X in one (9.09%) case. The treatment of choice was acyclovir in all patients, while corticosteroids were administered in six (54.55%) patients. Complete CN recovery was observed in seven (63.63%) patients, while four (36.36%) patients suffered from permanent CN damage-two (18.18%) CN VII, one (9.09%) CN VII and VIII, and one (9.09%) CN VI.

CONCLUSION

Herpes zoster CP presents an interesting diagnostic and therapeutic challenge. Successful management of these patients depends on a thorough knowledge of the anatomy and topodiagnostic of CNs. Early administration of antiviral agents is crucial in terms of responsiveness to treatment and expedite recovery.

Ramsay Hunt syndrome: long-term facial palsy outcome assessed face-to-face by three different grading scales and compared to patient self-assessment

Purpose

To determine the long-term facial palsy outcome of Ramsay Hunt Syndrome by face-to-face grading by House–Brackmann Grading System, Facial Nerve Grading System 2.0, and Sunnybrook Facial Grading System concomitantly. To compare the applicability of the grading scales. To compare patients’ self-assessed facial palsy outcome results to gradings performed by the investigator. To compare the face-to-face assessed facial palsy outcome to the initial palsy grade.

Methods

Fifty-seven patients self-assessed their facial palsy outcome and came to a one-time follow-up visit. The palsy outcome was graded by one investigator using the three above-mentioned grading systems concomitantly. The median time from syndrome onset to follow-up visit was 6.6 years.

Result

A good long-term face-to-face assessed palsy outcome was enjoyed by 84% of the patients. Trying to assess only one House–Brackmann grade to represent the palsy outcome was impossible for most patients. Facial Nerve Grading System 2.0 worked better, but needed adjustments and certain sequelae findings needed to be neglected for it to be executable. The Sunnybrook system worked the best. Nearly 20% of the patients assessed themselves differently from the investigator: both better and worse.

Conclusion

The Sunnybrook scale was the most applicable system used. With antiviral medication, the outcome of facial palsy in Ramsay Hunt syndrome starts to resemble that of Bell’s palsy and emphasizes the importance of recognizing the syndrome and treating it accordingly. The results give hope to patients instead of the gloomy prospects that have stigmatized the syndrome.

Non-recovery animal model of severe facial paralysis induced by freezing the facial canal

OBJECTIVE

Some cases of peripheral facial paralysis are resistant to treatment, thus, a non-recovery model of facial paralysis is needed to develop new treatment strategies for this condition. The purpose of the current study was to develop an animal model of which facial palsy was severe and prolonged.

METHODS

Ten 8-week-old female Hartley guinea pigs weighing between 400 and 500 g were used for the animal model. The vertical segment of the facial canal was accessed via the otic bulla, without removing the bony wall of the facial canal. The canal was then frozen for 5 s using freeze spray. Facial movements, electroneurography (ENoG), histology, and changes in temperature were evaluated.

RESULTS

All animals exhibited complete facial paralysis immediately after the procedure and recovered gradually, however, not all of them had recovered completely 15 weeks after freezing. The ENoG values one week after freezing for all animals (10/10) were 0%. Histological examination one week after freezing revealed that most of the vertically placed myelinated nerve fibers which had been frozen were remarkably affected and denatured. The number of vertically placed myelinated nerve fibers increased 15 weeks after freezing, but the nerve fibers were smaller than normal nerve fibers and were distorted in shape.

CONCLUSION

Complete facial paralysis was induced in Hartley guinea pigs by freezing the facial canal. The behavioral, ENoG, and histopathological data suggest that the facial paralysis was severe and prolonged. This model may assist in developing novel treatment for severe facial palsy and facilitate basic research on facial nerve regeneration.

Data for temporal facial nerve recovery in Ramsay Hunt syndrome following intratympanic steroid therapy

This article contains data related to the research article entitled "Concurrent treatment with intratympanic dexamethasone improves facial nerve recovery in Ramsay Hunt syndrome" (Akira Inagaki, Toshiya Minakata, Schiyo Katsumi, Shingo Murakami) [1]. This data article reports the protocol for a clinical trial investigating the benefit of intratympanic steroid therapy on facial recovery in Ramsay Hunt syndrome and temporal facial recovery. The data included in this article are as follows: inclusion and exclusion criteria, the treatment protocol of steroids and antiviral therapies, facial recovery as assessed by the House-Brackmann scale in all enrolled patients, House-Brackmann scores in patients with a poor electrophysiological result, and House-Brackmann scores after propensity score matching. This article will be useful for related investigations or clinical practices in the future by serving as a model and benchmark.

[Ramsay Hunt syndrome with hearing loss and vertigo]

The article contains literature review on etiology, natural history and treatment of Ramsay Hunt syndrome. Differential diagnosis in case of 8^th cranial nerve involvement is discussed. We present a case of the patient with Ramsay Hunt syndrome with hearing loss and vertigo is described. Clinical symptoms and diagnosis of sensorineural hearing loss and acute unilateral vestibulopathy are presented. The successful treatment of the patient resulted in complete facial nerve recovery, hearing improvement and partial recovery of vestibular function.

Ramsay Hunt syndrome: characteristics and patient self-assessed long-term facial palsy outcome

Purpose

To explore the characteristics, medical treatments, and long-term facial palsy outcome in Ramsay Hunt syndrome.

Methods

Patient questionnaire including self-assessment of long-term facial palsy outcome and retrospective chart review. Initial facial palsy grade was compared to self-assessed or patient record stated palsy outcome. Occurrence of different characteristics (blisters, hearing loss, vertigo, etc.) of the syndrome were assessed.

Results

Altogether 120 patients were included of which 81 answered the questionnaire. All but one patient had received virus medication (aciclovir, valaciclovir), and half received simultaneous corticosteroids. If the medication was started within 72 h of Ramsay Hunt diagnosis, facial palsy recovered totally or with only slight sequelae in over 80% of the patients. Only a minority of the patients experienced varicella blisters simultaneously with facial palsy, blisters more often preceded or followed the palsy. Approximately 20% of the patients had their blisters in hidden places in the ear canal or mouth.

Conclusions

The long-term outcome of facial palsy in medically treated Ramsay Hunt syndrome was approaching the outcome of Bell’s palsy. It is crucial to ask and inform the patient about the blisters and look for them since, more often than not, the blisters precede or follow the palsy and can be in areas not easily seen.

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

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.

A High Neutrophil-to-Lymphocyte Ratio Is Associated with Recovery from Ramsay Hunt Syndrome

BACKGROUND

Prediction of the severity and outcomes of Ramsay Hunt syndrome (RHS) is difficult.

OBJECTIVES

The aim of this study was to evaluate the predictive power of the neutrophil-to-lymphocyte ratio (NLR) for the severity and outcomes of RHS.

MATERIAL AND METHODS

From 2007 to 2017, a retrospective study of 102 hospitalized patients with RHS was conducted. The degree of paralysis was assessed by determining the House-Brackmann (H-B) grade. Obesity, hypertension, and diabetes mellitus were assessed, and the blood NLR and platelet-to-lymphocyte ratio were determined. The patients received steroids and antivirals, and were followed in the outpatient department at 1, 4, 12, and 24 weeks.

RESULTS

The H-B grade of the high-NLR group was significantly higher than that of the normal-NLR group (p = 0.039), and the probability of complete recovery was significantly lower in the high-NLR group (p = 0.048).

CONCLUSIONS

Patients with RHS who have an elevated NLR have poor outcomes in terms of the H-B grade. Therefore, the NLR may be useful for evaluating the prognosis of patients with RHS.

Contrast-enhanced magnetic resonance imaging of facial nerve swelling in patients with severe Ramsay Hunt syndrome

OBJECTIVE

In Ramsay Hunt syndrome, contrast enhancement of magnetic resonance (MR) imaging seen in the affected facial nerve in the majority of cases, but its clinical significance has not been well investigated to date. The aim of this study was to elucidate the clinical significance of this imaging sign by quantitively investigating the correlation between the signal increase and swelling of the facial nerve. We also investigated the temporal change in this sign and its correlation with recovery.

METHODS

We retrospectively evaluated swelling of the facial nerve in 16 patients with severe Ramsay Hunt syndrome who underwent both contrast-enhanced magnetic resonance imaging and facial nerve decompression surgery via a transmastoid approach alone or in combination with a middle cranial approach. All the patients had a Yanagihara score of ≤8 points and facial nerve degeneration of ≥90% confirmed by either a nerve excitability test or electroneurography. Swelling of the facial nerve was evaluated intraoperatively using a 4-point grading system.

RESULTS

A significant correlation was observed between contrast enhancement on T1-weighted images and facial nerve swelling in the labyrinthine segment, geniculate ganglion, and pyramidal segment (P = 0.030, P = 0.018, and P = 0.037, respectively). Furthermore, the contrast enhancement increased significantly as more time elapsed after the onset of facial palsy (mean ± standard error, 14.7 ± 2.3 days, range, 5-42 days) in the geniculate ganglion and pyramidal segment (correlation coefficient, 0.546 and 0.689, P = 0.022 and P = 0.002, respectively). Patients with good recovery (Yanagihara score of ≥36) showed significantly lower contrast enhancement in the tympanic and mastoid segments (P = 0.021 and 0.020, respectively) than those who with poor recovery.

CONCLUSION

In particular segments of the facial nerve, contrast enhancement on T1-weighted image correlated with facial nerve swelling and recovery. These observations underscore the clinical significance of contrast enhancement on T1-weighted images in patients with Ramsay Hunt syndrome.

A case study of Ramsay Hunt Syndrome in conjunction with cranial polyneuritis

RATIONALE

Ramsay Hunt syndrome in conjunction with cranial polyneuritis is not extensively documented, and is very easily misdiagnosed.

PATIENT CONCERNS

A case of a 53-year-old male with Ramsay Hunt syndrome in conjunction with cranial polyneuritis is presented with early symptoms of vertigo, cephalalgia, and facial palsy, followed by zoster oticus 10 days later.

DIAGNOSES

Diagnosis was challenging as this condition presents with multiple neuropathies, and attempting to diagnose based on clinical symptoms was often misleading. Polymerase chain reaction can be used to test for presence of the virus in the cerebrospinal fluid, followed by targeted drug therapy.

INTERVENTIONS

Acupuncture, in conjunction with fire cupping, bloodletting around the afflicted region on the face, as well as oral consumption of herbal medicine and vitamins for nerve nourishment was given to treat this disease.

OUTCOMES

Due to misdiagnosis resulting in delayed treatment, peripheral facial paralysis was left as the main sequelae, while other symptoms responded quickly to treatment. After a 6-month follow-up, facial palsy was still present.

LESSONS

Considering that targeted antiviral therapy can be used to increase the effectiveness of treatment, early diagnosis, and timely use of medication is critical.

Ramsay Hunt Syndrome with Multiple Cranial Neuropathies: Role of Pulse Steroid Therapy with Newer Antiviral Agent in Nonresponding Hiccoughs and Laryngeal Palsy

Ramsay hunt syndrome (RHS) is characterised by herpetic blisters (small vesicles) of the skin of the external canal, pinna and/or the oral mucosa and severe otalgia (ear pain) along with acute peripheral facial paralysis and/or vestibulocochlear dysfunction (e.g., vertigo, hearing loss, hyperacusis, tinnitus). RHS with multiple cranial neuropathies is rare, more severe, and usually intractable. A combination therapy of antiviral agents and steroids is the preferred treatment. We present a case of 30-year-old man suffering from RHS with multiple cranial neuropathies treated effectively with combination therapy of intravenous pulse steroid therapy and newer antiviral agent for intractable hiccoughs and laryngeal palsy.

Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature

Introduction Ramsay Hunt syndrome is the second most common cause of facial palsy. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction. Objective The objective of this study is to review the prognosis of the facial palsy on Ramsay Hunt syndrome, considering the different treatments proposed in the literature. Data Synthesis We read the abstract of 78 studies; we selected 31 studies and read them in full. We selected 19 studies for appraisal. Among the 882 selected patients, 621 (70.4%) achieved a House-Brackmann score of I or II; 68% of the patients treated only with steroids achieved HB I or II, versus 70.5% when treated with steroids plus antiviral agents. Among patients with complete facial palsy (grades V or VI), 51.4% recovered to grades I or II. The rate of complete recovery varied considering the steroid associated with acyclovir: 81.3% for methylprednisolone, 69.2% for prednisone; 61.4% for prednisolone; and 76.3% for hydrocortisone. Conclusions Patients with Ramsay-hunt syndrome, when early diagnosed and treated, achieve high rates of complete recovery. The association of steroids and acyclovir is better than steroids used in monotherapy.

Ramsay Hunt Syndrome Associated with Central Nervous System Involvement in an Adult

Ramsay Hunt syndrome associated with varicella zoster virus reactivation affecting the central nervous system is rare. We describe a 55-year-old diabetic female who presented with gait ataxia, right peripheral facial palsy, and painful vesicular lesions involving her right ear. Later, she developed dysmetria, fluctuating diplopia, and dysarthria. Varicella zoster virus was detected in the cerebrospinal fluid by polymerase chain reaction. She was diagnosed with Ramsay Hunt syndrome associated with spread to the central nervous system. Her facial palsy completely resolved within 48 hours of treatment with intravenous acyclovir 10 mg/kg every 8 hours. However, cerebellar symptoms did not improve until a tapering course of steroid therapy was initiated.

Mime therapy for Ramsay Hunt syndrome: A case study

Background/Aim:

There are limited physiotherapy interventions and lack of significant outcome for Ramsay Hunt syndrome. This case report is the first to our knowledge that uses mime therapy as physiotherapy treatment for Ramsay Hunt syndrome.

Method:

A 53-year-old male patient received mime therapy along with electrical stimulation at two and half months post-diagnosis. The patient received electrical stimulation at the first week intervention as 30 minutes per session for 5 days a week and was discontinued at the third week intervention because the patient could not continue with facial muscle stimulation at home. Mime therapy was given three times a week for 13 weeks, with a total of 24 visits spread over 3 months.

Findings:

Facial symmetry was measured using the Sunnybrook Facial Grading System and severity of paresis was measured using the House-Brackmann scale throughout the course of treatment. House-Brackmann grades improved from grade V to grade II. Facial symmetry and synkinesis also improved. The facial disability index also showed improvement in both the physical function and social/wellbeing subscale components (Initial scores: physical subscale = 35/100; social/wellbeing subscale = 55/100. The final scores: physical subscale = 75/100; social/wellbeing subscale = 85/100).

Conclusions:

Overall, mime therapy was effective and benefits are stable for the short term. Therefore, mime therapy can be a good treatment choice for patients with Ramsay Hunt syndrome. Further research should include randomised controlled trials with a large sample size to prove its long-term effects.

Disseminated herpes zoster in an immunocompetent elderly patient

Herpes zoster is a cutaneous infection that is characterized by an acute vesicobullous rash with ipsilateral one or two dermatomal distribution and painful allodynia, while predominantly being found in the elderly. Extensive cutaneous dissemination has been reported in immune-compromised patients, such as those who suffer from HIV infections, cancer, chemotherapy, and corticosteroid therapy patients. However, we report a case of disseminated herpes zoster infection in an immuno-competent elderly individual.