対側三叉神経領域に帯状疱疹を併発したラムゼイ ハント症候群例

抄録

We report a rare case of Ramsay Hunt syndrome in a patient with herpes zoster affecting the contralateral trigeminal nerve. A 69-year-old woman presented with a history of having become aware of a painful rash on the left forehead since 4 days prior to her first visit to our otolaryngology department. Three days later, she was referred to our dermatology department and was diagnosed as having ophthalmic zoster. In the evening on the same day, she noticed that she could not drink liquids through a straw. At her first visit, examination revealed painful redness in the right external ear and external auditory canal. Right facial palsy was also seen, with a score of 12 on the Yanagihara facial nerve grading system. In the audiogram, while there was no significant difference between the two sides, the hearing threshold of 8 kHz on the right side was 15 dB worse than that on the left side. Stapedial reflexes were positive on both sides. In the electric taste tests, the thresholds in the right chorda tympani nerve and greater petrosal nerve regions were outside the scale, whereas those in the right and left glossopharyngeal nerve regions were within the normal range. From her first visit, she was begun on intravenous hydrocortisone treatment, with gradual tapering of the dose from 500 mg daily, for 14 days. Antiviral drug was also administered. ENoG performed on day 10 after the initial visit was 65%. The prognosis was anticipated to be good. By day 22 after the initial visit, the redness of the right auricle disappeared, and by day 27, the facial nerve paralysis also resolved. The test for virus antibody (EIA) performed on day 13 after the initial visit revealed a significant increase in the VZV IgG titer. As the mechanism of onset in this case, transmission through the cerebrospinal fluid or simultaneous reactivation of latent VZV in the ganglion of the opposite side was speculated.