Ramsay Hunt Syndrome

dok_zlo — 15.06.2025

A previously healthy 48-year-old woman presented to the dermatology clinic with a 1-day history of a rash on her right ear that was preceded by 2 days of ear pain and an inability to move the right side of her face. Physical examination was notable for facial-nerve palsy on the right side (Panel A) and erythema with a few vesicles and some crusting on the pinna of the right ear (Panel B). An oral examination revealed vesicles on the right side of the hard palate, patchy erythema of the anterior tongue, and an ulceration on the right lower lip (Panel C). Her hearing was intact. A diagnosis of the Ramsay Hunt syndrome — also known as herpes zoster oticus — was made. The Ramsay Hunt syndrome occurs when varicella–zoster virus reactivates in the geniculate ganglion, a sensory ganglion in the facial nerve that innervates parts of the ear and tongue. Ear pain, ear vesicles, and ipsilateral facial palsy result. Treatment with an antiviral agent, a glucocorticoid, and pregabalin was given. The ear pain and mucocutaneous lesions had resolved 3 weeks after the initial presentation, with near-complete resolution of the facial palsy (improvement from grade 5 to grade 2 on the House–Brackmann scale [scores range from 1 to 6, with 1 indicating normal function]) at 12 weeks.
Jiangtao Guo, M.S., and Wenbin Li, M.D.
Published June 11, 2025
N Engl J Med 2025;392: e53
DOI: 10.1056/NEJMicm2500293
VOL. 392 NO. 22

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