Zoster oticus and its complications. Ramsay Hunt syndrome. Report of three cases

Introduction . Herpes zoster oticus is caused by varicella zoster virus (VZV), affecting 10-20% of the population. Ramsay Hunt syndrome, a complication of herpes zoster oticus, presents a reactivation of latent VZV infection in the sensory dorsal root ganglia of the facial nerve.

Objective . To present three patients in whom a VZV infection caused complications in the course of zoster oticus.

Case report . Erythematous and oedematous skin lesions with vesicles in the right auricle and dizziness appeared in an 87-year-old woman 10 days before admission to the ward. After a few days, shivering and fever (39°C) developed. During hospitalization peripheral facial paralysis was observed. In the second patient, left-sided facial palsy was preceded by acute pharyngalgia and pain of the left ear with skin hyperesthesia and vesicles in the left external auditory canal. In the third patient, the first symptoms were pain and oedema of the right ear. After a few days, vesicles in the right auricle and hard palate and right-sided facial palsy occurred. The systemic and topical treatment led to healing of skin lesions. In one case, facial palsy and partial hearing loss persisted.

Conclusions . In the presented cases, VZV infection was complicated by facial paralysis and dizziness, partial hearing loss and erysipelas in one patient. Old age, diabetes mellitus, arterial hypertension are prognostic factors of severe complications and decreased chance of complete recovery.