A Case of Ramsay Hunt Syndrome Associated with Aseptic Meningitis / 대한소아신경학회지

ABSTRACT

Ramsay Hunt syndrome(RHS or herpes zoster oticus) is caused by reactivation of latent varicella-zoster virus(VZV) in the geniculate ganglion of the seventh cranial nerve. Unilateral facial paralysis is accompanied by herpetic vesicles on the external auditory canal or in the mouth. The prognosis is not good as that of idiopathic facial palsy. Aggressive treatment with acyclovir, in combination with steroids, is recommended. RHS is thought to affect adults primarily, but a few cases of children with RHS have been reported. We present a case of RHS combined with aseptic meningitis in a previously healthy 10-year-8-month-old boy. He showed a complete peripheral facial palsy on the right side with CSF pleocytosis. Eight days after the onset of the facial palsy, the characteristic herpetic vesicles appeared on the pinna of the right side. The analysis of sera confirmed the clinical diagnosis of RHS with a positive IgG and IgM-ELISA antibody titer of VZV. Although we administered acyclovir and prednisolone adequately to the patient, he has shown an incomplete recovery of the facial palsy on a follow-up visit. The physicians should be prudent in the diagnosis of idiopathic facial palsy or RHS, and must watch for the appearance of vesicles in children with facial palsy.