Disseminated herpes zoster presenting as atypical Ramsay-Hunt syndrome with oral lesions: A case report

Shingles is caused by reactivation of latent varicella-zoster virus infection and can become generalized if immunity is weakened for any reason. Ramsay-Hunt syndrome is a rare manifestation of varicella-zoster virus reactivation. According to Goswami and Gaurkar (2023), it accounts for less than 1% of cases. The disease is classified as typical or atypical according to the clinical manifestations. We present a rare case of an 87-year-old woman with atypical Ramsay-Hunt syndrome and disseminated herpes zoster. At the initial examination, the only findings were vesicles on the palate and white moss-like lesions on the tongue. The following day, the patient developed right otalgia and herpes zoster was suspected. Antiviral drug administration was initiated immediately. On Day 2 of hospitalization, a disseminated vesicular eruption and right facial nerve paralysis appeared. However, vesicles did not appear in the ear canal or pinna and no vestibulocochlear dysfunction was observed; therefore, we diagnosed atypical Ramsay-Hunt syndrome with disseminated herpes zoster. The rash and right facial nerve paralysis persisted. Herpes zoster, even if confined to oral mucosa, is an important sign that should raise suspicion of incomplete Ramsay-Hunt syndrome. Ramsay-Hunt syndrome can cause severe and persistent symptoms; therefore, it should be diagnosed and treated as early as possible.