Laryngeal Mass with Multiple Cranial Neuropathies as a Presenting Sign for Varicella Zoster Infection

Abstract

The most common presentation of varicella zoster virus (VZV) infection is unilateral distribution of herpetic eruptions and neuralgia. Laryngeal involvement is considered very rare.

Herpetic cranial polyneuritis mimicking brain stem infarction—an atypical presentation of Ramsay Hunt syndrome

“…Despite treatment, recovery of UVCP can be delayed beyond 8 months and persistent bulbar symptoms, residual hearing loss, incomplete recovery of FNP and postherpetic neuralgia are not uncommon 20. RHS in patients under the age of 50 years should prompt further investigation to exclude causes of immunodeficiency 20…”

A Supraglottic Pseudotumor in an Immunocompromised Patient with Nephrotic Syndrome, Herpes Zoster, and a Cytomegalovirus Infection

“…Laryngeal zoster, a phenotype of HZ in the head and neck, includes a wide spectrum of manifestations, such as laryngeal mucosal eruptions, skin erythema, and multiple cranial nerve palsies. [13][14][15][16][17] VZV reactivation in the larynx may also mimic neoplasms by presenting with laryngeal masses, [18][19][20] and cases of laryngeal zoster without motor dis orders or mucosal lesions are not exceptional. 14,16,21 Therefore, the laryngeal mass in the current patient can be attributed to a VZVdependent mechanism, and it is thus not surprising that we failed to confirm any signs suggestive of laryngeal paresis, such as hoarseness or dysphagia, on the initial presentation, in addition to mucosal eruptions.…”

“…14,16,21 Therefore, the laryngeal mass in the current patient can be attributed to a VZV-dependent mechanism, and it is thus not surprising that we failed to confirm any signs suggestive of laryngeal paresis, such as hoarseness or dysphagia, on the initial presentation, in addition to mucosal eruptions. Considering the innervation of the laryngeal area, the concurrent VZV reactivation with vagus nerve involvement may have played a role, 13,18,20 at least in part, in the establishment of the cervical manifestations in the current patient. Despite the absence of a vesicular rash, the detection of a tender erythematous patch over the perilaryngeal skin, which did not accord with the dermatomal distribution in the cervical region, may be a subtype of a cutaneous manifestation of presumable vagal VZV mononeuritis, as described by Wu et al 13 Otherwise, one may argue that the involvement of a bacterial infectious process, such as paralaryngeal abscess formation, cannot be excluded.…”

Varicella Zoster Meningitis Presenting With Isolated Dysphagia, Dysarthria and Dysphonia

“…5 In 2 cases of VZV meningoencephalitis where dysphagia and dysarthria were the initial complaint, both patients developed facial weakness again leading to a presentation of multiple cranial neuropathies as often seen with VZV. 9 Our case is unique in that the VZV only affected cranial nerves IX and X and resulted in a focal medullary hyper intensity on T2 FLAIR. It is postulated that retrograde transmission from the pharyngeal mucosa through the vagal and glossopharyngeal nerves to the medulla is the mechanism for VZV spread in this case.…”