A Case of Mri-Negative Herpes Virus Encephalitis
Presented by Ramsay Hunt Syndrome

Dyachenko, Pavel; Dyachenko, Anatoly G

doi:10.36740/wlek202011139

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…However, in this patient MRI was normal. Review of literature revealed that MRI and other neuroimaging being normal in such patients have been reported before [10].…”

Section: Case Reportmentioning

confidence: 99%

Ramsay Hunt Syndrome with cranial polyneuropathy and aseptic meningoencephalitis: A case report

Soysa¹,

Sivagnanam

2023

Anuradhapura Med. J.

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Ramsay Hunt Syndrome is characterized by paroxysmal ear pain, and vesicular rash around the ear with ipsilateral facial nerve palsy. It is due to the reactivation of the Varicella Zoster Virus (VZV) in the facial nerve ganglion. It is considered the second most common cause of peripheral facial nerve palsy. A 14-year-old immunocompetent boy presented with fever associated with vertigo, facial asymmetry and difficulty in swallowing. He had a few crusted lesions in his left ear pinna and ear canal on examination. A cranial nerve examination revealed a left-sided facial and palatal palsy. Cerebrospinal fluid (CSF) analysis was suggestive of a viral meningoencephalitis.This case highlights the importance of clinicians recognizing Ramsay Hunt syndrome amongst patients presenting with multiple cranial nerve involvement and amongst those with meningoencephalitis.

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“…However, in this patient MRI was normal. Review of literature revealed that MRI and other neuroimaging being normal in such patients have been reported before [10].…”

Section: Case Reportmentioning

confidence: 99%

Ramsay Hunt Syndrome with cranial polyneuropathy and aseptic meningoencephalitis: A case report

Soysa¹,

Sivagnanam

2023

Anuradhapura Med. J.

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“… 2 These are exceedingly rare complications, with VZV meningoencephalitis or RHS occurring in <1% of OHT recipients 3 , 4 and co-occurring in just a few case reports amongst exclusively non-OHT patients. 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

The risks of rejection vs. infection: Ramsay Hunt syndrome, Gradenigo syndrome, and varicella meningoencephalitis in a heart transplant patient

Benavente

Kozai

Silangcruz

et al. 2023

European Heart Journal - Case Reports

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Background Orthotopic heart transplant (OHT) recipients are at increased risk for varicella-zoster reactivation, and severe complications may arise due to their immunosuppressive regimens. Managing immunosuppression in acute infection is difficult, and specific guideline recommendations or evidence from the literature is lacking. However, patient care must involve weighing the risk of transplant rejection with the consequences of worsening infection. Case Summary An OHT patient with history of multiple episodes of acute rejection, latent varicella zoster virus (VZV) infection, and recent completion of anti-viral prophylaxis presented with unilateral facial droop and pain, abducens nerve palsy, crusting facial rash, and ear swelling. Imaging revealed necrotizing otitis externa, with associated otitis media, and petrous apicitis concerning for Gradenigo Syndrome. A VZV-positive viral panel confirmed our suspicion for Ramsay Hunt Syndrome (RHS). The patient's mentation continued to decline, and subsequent lumbar puncture also revealed VZV meningoencephalitis. The patient’s mycophenolate mofetil (MMF) was suspended, with continuation of tacrolimus, and initiation of intravenous acyclovir. The patient demonstrated gradual resolution of his infection, without developing any signs of acute rejection. Discussion VZV reactivation is common in OHT patients, particularly when viral prophylaxis is discontinued, however cardiologists should be aware of the rarer manifestations that can manifest in these immunocompromised patients. This is the first documented case of simultaneous RHS, Gradenigo syndrome and VZV meningoencephalitis in any patient, regardless of transplant status. We demonstrate that even in patient at very high risk of rejection, MMF can be safely discontinued, and host immunity maintained with temporary tacrolimus monotherapy.

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A Case of Mri-Negative Herpes Virus Encephalitis Presented by Ramsay Hunt Syndrome

Cited by 2 publications

References 6 publications

Ramsay Hunt Syndrome with cranial polyneuropathy and aseptic meningoencephalitis: A case report

Ramsay Hunt Syndrome with cranial polyneuropathy and aseptic meningoencephalitis: A case report

The risks of rejection vs. infection: Ramsay Hunt syndrome, Gradenigo syndrome, and varicella meningoencephalitis in a heart transplant patient

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