Ramsay Hunt Syndrome with Cranial Polyneuropathy and Aseptic Meningoencephalitis: A Case Report

Introduction: Ramsay Hunt Syndrome is characterized by paroxysmal ear pain, vesicular rash around the auricle and ear canal with ipsilateral peripheral fascial nerve palsy. It is due to reactivation of Varicella Zoster Virus (VZV) in the fascial nerve ganglion. It is considered to be the second most common cause of peripheral fascial nerve palsy. Involvement of other cranial nerves is uncommon. Rarely, dissemination of infection can lead to meningoencephalitis.

Case Presentation: A 14-year-old immunocompetent boy presented with fever associated with vertigo, fascial asymmetry and difficulty in swallowing. He also complained of a rash on his left ear associated with ear pain, one week prior to this presentation. He had a few crusted lesions on his left ear pinna and ear canal on examination. Cranial nerve examination revealed a left sided lower motor neuron type fascial and palatal palsy. Cerebrospinal fluid (CSF) analysis was suggestive of viral meningoencephalitis. He was treated for Ramsay Hunt Syndrome with cranial polyneuropathy and meningoencephalitis with Acyclovir and steroids. He had a uncomplicated recovery.

Conclusion: This case highlights the importance of clinicians diagnosing Ramsay Hunt Syndrome amongst patients presenting with multiple cranial nerve palsies and meningoencephalitis. It is a reminder that careful history and meticulous examination can lead to prompt recognition of a reversible cause of cranial polyneuropathy.