Herpes Zoster Laryngitis Presenting as Unilateral Vocal Fold Paralysis With Delayed Facial Palsy: A Case Report

Herpes zoster laryngitis (HZL) is a rare manifestation of varicella-zoster virus (VZV) infection involving the larynx. It typically presents with sore throat, odynophagia, hoarseness, and unilateral vesicular or ulcerative mucosal lesions. Because of its rarity and nonspecific clinical manifestations, HZL is frequently misdiagnosed as viral laryngopharyngitis, laryngeal malignancy, or Ramsay Hunt syndrome. A 66-year-old woman presented with hoarseness and unilateral vocal fold paralysis accompanied by ipsilateral arytenoid swelling and an ulcerative laryngeal lesion. The lesion was initially suspected to represent laryngeal malignancy, and a biopsy was performed. Histopathological examination confirmed herpetic infection consistent with HZL. Approximately 2 weeks after the initial presentation, the patient developed delayed-onset House-Brackmann Grade III facial nerve palsy. Following treatment with systemic antiviral agents and corticosteroids, both the laryngeal lesion and facial palsy gradually improved. HZL should be considered in patients presenting with unilateral vocal fold paralysis and ulcerative laryngeal lesions, even in the absence of facial nerve involvement at initial presentation. Delayed facial palsy may occur during the disease course, highlighting the importance of early recognition, pathological confirmation when indicated, and prompt antiviral treatment.