Ostwal Shrenik, Salins Naveen, Deodhar Jayita, Muckaden Mary Ann
Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Indian J Palliat Care. 2015 Jan-Apr;21(1):79-81. doi: 10.4103/0973-1075.150195.
The Ramsay Hunt syndrome is characterized by combination of herpes infection and lower motor neuron type of facial nerve palsy. The disease is caused by a reactivation of Varicella Zoster virus and can be unrepresentative since the herpetic lesions may not be always be present (zoster sine herpete) and might mimic other severe neurological illnesses.
A 63-year-old man known case of carcinoma of gall bladder with liver metastases, post surgery and chemotherapy with no scope for further disease modifying treatment, was referred to palliative care unit for best supportive care. He was on regular analgesics and other supportive treatment. He presented to Palliative Medicine outpatient with 3 days history of ipsilateral facial pain of neuropathic character, otalgia, diffuse vesciculo-papular rash over ophthalmic and maxillary divisions of left trigeminal nerve distribution of face and ear, and was associated with secondary bacterial infection and unilateral facial edema. He was clinically diagnosed to have Herpes Zoster with superadded bacterial infection. He was treated with tablet Valacyclovir 500 mg four times a day, Acyclovir cream for local application, Acyclovir eye ointment for prophylactic treatment of Herpetic Keratitis, low dose of Prednisolone, oral Amoxicillin and Clindamycin for 7 days, and Pregabalin 150 mg per day. After 7 days of treatment, the rash and vesicles had completely resolved and good improvement of pain and other symptoms were noted.
Management of acute infections and its associated complications in an acute palliative care setting improves both quality and length of life.
拉姆齐·亨特综合征的特征是疱疹感染与下运动神经元型面神经麻痹并存。该疾病由水痘-带状疱疹病毒重新激活引起，可能不具有典型表现，因为疱疹性损害可能并不总是存在（无疱疹性带状疱疹），且可能会与其他严重神经系统疾病相似。
一名63岁男性，已知患有胆囊癌伴肝转移，接受手术和化疗后，已无进一步进行疾病改善治疗的机会，被转至姑息治疗科接受最佳支持治疗。他正在接受常规镇痛药物及其他支持性治疗。他因出现同侧神经性面部疼痛、耳痛、左侧三叉神经眼支和上颌支分布区域的面部及耳部弥漫性水疱-丘疹皮疹3天，且伴有继发性细菌感染和单侧面部水肿，就诊于姑息医学门诊。临床诊断为带状疱疹合并细菌感染。给予其伐昔洛韦片500毫克，每日4次，外用阿昔洛韦乳膏，预防性使用阿昔洛韦眼膏治疗疱疹性角膜炎，小剂量泼尼松龙，口服阿莫西林和克林霉素7天，以及普瑞巴林每日150毫克。治疗7天后，皮疹和水疱完全消退，疼痛及其他症状明显改善。
在急性姑息治疗环境中对急性感染及其相关并发症进行管理可改善生活质量和延长生存期。
