Ramsay Hunt syndrome and viral meningitis: an association underreported in the literature

Abstract

Introduction: Ramsay Hunt Syndrome, a rare clinical entity, is caused by the reactivation of the varicella zoster virus, which results in inflammation of the geniculate ganglion of the facial nerve. Characterized by the triad: ipsilateral facial paralysis, otalgia and herpetic vesicles in the external ear. Due to the broad symptomatology, which encompasses atypical symptoms and present in several other pathologies, it is often underdiagnosed. Case report: A 62-year-old woman admitted to Hospital Evangélico de Londrina due to paresthesia in the left hemiface, associated with vertigo and severe headache. On physical examination, peripheral facial paralysis on the left and vesicles on the palate and left external ear were observed. AVC protocol exams were requested (normal) and liquor was collected (clear, colorless appearance, 92% lymphocytes). New serologies and magnetic resonance imaging of the skull with contrast were requested. Prescribed acyclovir, prednisone, eye drops and ocular occlusion. The patient evolved with maintenance of headache and otalgia. Prednisone was replaced by intravenous dexamethasone, gabapentin and topical lidocaine were added, and other medications were maintained. Non-reactive requested serologies. Analysis of the herpes simplex virus by polymerase chain reaction > 30. In view of the data, a diagnosis of viral meningitis due to herpes associated with Ramsay Hunt syndrome was diagnosed. Maintained treatment, patient evolved with improvement of the condition. Conclusion: Based on the clinical correlation and unfavorable prognosis, the importance of early identification and treatment lies in order to reduce the time of active disease and neural damage, avoiding possible complications.