抄録
We report a rare preschool case of Ramsay Hunt syndrome with delayed herpes zoster oticus presentation over a week following facial paralysis.
A 5-year-old girl found by her guardians to have right facial palsy had neither herpetic eruptions nor the eighth cranial nerve disorders on the first visit. She was therefore diagnosed with severe Bell’s palsy (6/40 points) and administered steroid—10 mg/kg of hydrocortisone—alone intravenously for 7 days. On the evening of the last infusion day, she reported right earache and was found to have auricular swelling, after which and the diagnosis was changed to Ramsay Hunt syndrome. Intravenous administration of acyclovir with the same dose of steroid was given, but electroneuronography (ENoG) was 0% on the last infusion day. Following this assessment, transmastoid decompression surgery was conducted on day 16. Her facial movement recovered up to 34/40 3 months postoperatively. Serologically, anti-VZV IgG was significantly elevated.
Viral facial nerve paralysis origin is believed to be by far rarer than pediatric idiopathic facial palsy, so steroid alone is usually administered. Those insufficiently immune to VZV, however, risk early viral reactivation, if acyclovir was given for chicken pox or subjects were affected by varicella before becoming 1 year old. Our case underscores the need to use concomitant antiviral agents with the steroid. Acyclovir should be considered especially in those with suspected low VZV immunity.
