ABSTRACT
Ramsay Hunt's syndrome is an infectious cranial polyneuropathy caused by varicella zoster, the herpetic virus that also causes chickenpox and shingles. Its symptoms include facial paralysis, ear pain, and an auricular rash. Oral lesions are also present in most cases. This syndrome can affect any cranial nerve and usually affects multiple nerves, causing central, cervical, and peripheral effects. This article reports the case of a 35-year-old white female who was treated by the oral surgery service of a large urban hospital, after first reporting to the emergency clinic. Her reported symptoms of unilateral left-side facial paralysis, auricular pain, and trigeminal hyperesthesia were confirmed by clinical examination. An initial short low-dose steroid regimen was unsuccessful. A second daily dosage of 50 mg of prednisone was successful in 21 days. No permanent sequelae were evident or reported after treatment.
Subject(s)
Cranial Nerve Diseases/virology , Facial Pain/virology , Herpes Zoster/diagnosis , Polyneuropathies/virology , Adult , Cranial Nerve Diseases/diagnosis , Cranial Nerve Diseases/drug therapy , Earache/diagnosis , Earache/drug therapy , Earache/virology , Facial Pain/diagnosis , Facial Pain/drug therapy , Facial Paralysis/drug therapy , Facial Paralysis/virology , Female , Herpes Zoster/drug therapy , Herpes Zoster Oticus/diagnosis , Herpes Zoster Oticus/drug therapy , Humans , Polyneuropathies/drug therapy , Prednisone/therapeutic use , SyndromeABSTRACT
Staphylococcus aureus has long been known as one of the most virulent microbes, with capabilities that make it threatening in both nosocomial and community-acquired infections. It remains the most frequent cause of skin-structure and traumatic infections in the community. S. aureus infections in the maxillofacial region are likely to be associated with a known portal of entry, but this is not always the case. Once invasion occurs, the organism may produce virulent enzymes including coagulase, hyaluronidase, proteases, DNA-ase, lipases, hemolysins, and lysozyme as well as exotoxins. Markel et al point out that cellulitis associated with coagulase-positive staphylococci will often resolve without abscess formation. Hence, there is often no site from which to obtain specimens, making this infection a diagnostic and therapeutic challenge. This report describes an infection in which the etiologic organism was identified as S. aureus. The source of the infection, however, remained unclear.
