Ramsay-Hunt syndrome associated with meningitis and vasculitis in an immunocompetent individual

Authors

  • Flávia Carolina Soares Bonato Instituto de Infectologia Emílio Ribas, Departamento de Doenças Infecciosas - São Paulo - São Paulo - Brasil
  • Rene Leandro Magalhães Rivero Instituto de Infectologia Emílio Ribas, Setor de Radiologia, Divisão de Apoio ao Diagnóstico e Terapêutica - São Paulo - SP - Brasil
  • José Ernesto Vidal Instituto de Infectologia Emílio Ribas, Departamento de Neurologia - São Paulo - SP - Brasil

DOI:

https://doi.org/10.5935/2764-734X.e20240340

Keywords:

Herpes Zoster Oticus, Central Nervous System, Vasculitis, Meningitis Viral, Varicella Zoster Virus Infection, Case Report

Abstract

The varicella zoster virus (VZV) causes chickenpox as a primary infection and its reactivation leads to herpes zoster, which is a painful vesicular rash with dermatomal distribution associated with neuralgia. It may also be reactivated in the central nervous system in the form of meningitis, meningoradiculitis, myelopathy, vasculitis and Ramsay-Hunt syndrome. In this report, we describe the case of a previously healthy 22-year-old man who presented with right hemiplegia and peripheral facial paralysis associated with painful vesicles in the ipsilateral auditory pavilion, accompanied by fever and headache. Magnetic resonance imaging of the brain, with a study of the arterial vessels, revealed findings compatible with vasculitis in the long segment of the left internal carotid artery. Although molecular biology tests of cerebrospinal fluid for herpes family viruses were negative, high titers of immunoglobulin G antibodies to varicella zoster in two different peripheral blood samples were observed. Two weeks after initiating treatment with parenteral acyclovir, the patient was asymptomatic and his neurological deficits improved significantly. This report highlights the importance of VZV reactivation as a cause of meningitis and vasculitis in young, immunocompetent individuals without comorbidities.

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Published

2024-04-30

How to Cite

Bonato, F. C. S., Rivero, R. L. M., & Vidal, J. E. (2024). Ramsay-Hunt syndrome associated with meningitis and vasculitis in an immunocompetent individual. Infections in Evidence, 3, e20240340. https://doi.org/10.5935/2764-734X.e20240340

Issue

Vol. 3 (2024)

Section

Case Reports

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