ABSTRACT
Varicella zoster virus (VZV) infection is due to VZV reactivation in most cases. The infection rate ranges from 4% to 12% in renal allograft recipients. Ramsay Hunt syndrome (RHS) is a rare manifestation of VZV infection. RHS typically presents as severe ear pain, small vesicles, and facial palsy. We reported a case of a 60-year-old man with an unusual clinical course who underwent living donor renal transplantation. He complained of severe ear pain but did not show vesicles or facial palsy. He also presented lesions indicating a fungal infection. Diagnosis of RHS was delayed since facial palsy did not develop until some days later. Although the denervation rate was high, he showed recovery of nearly all symptoms after antiviral treatment. Solid organ recipients may not typically show presentation of viral infection, and therefore clinical suspicion is important. Even though the final diagnosis is delayed, we must treat patients since they may recover well in contrast with the average population.