Kakeeto James, Atukunda Ronaldine Anne, Asio Priscilah, Pitua Ivaan
School of Medicine, College of Health Sciences Makerere University Kampala Uganda.
Clin Case Rep. 2025 Feb 24;13(3):e70272. doi: 10.1002/ccr3.70272. eCollection 2025 Mar.
Ramsay Hunt syndrome (RHS) is a rare complication of varicella-zoster virus (VZV) reactivation, typically presenting with a combination of painful vesicular lesions in the ear, facial nerve palsy, and hearing loss. Early diagnosis and antiviral therapy are critical in minimizing long-term sequelae, such as persistent facial weakness and hearing impairment. This case highlights the importance of prompt recognition and treatment in older patients, particularly those with pre-existing hearing difficulties. An 87-year-old female presented with a 2-week history of painful, blister-like lesions on the right ear and lips, associated with a burning sensation. Over several days, the lesions progressed to visible wounds. The patient also reported increasing weakness, difficulty eating, and worsening hearing impairment. Physical examination revealed vesicular lesions on the right pinna and lips, along with right-sided facial weakness (House-Brackmann Grade IV) and slight ipsilateral lagophthalmos with mild conjunctival erythema. No new vesicles or generalized rash were observed. The patient's medical history included hypertension and long-standing bilateral hearing difficulty. Ramsay Hunt syndrome was diagnosed based on the characteristic symptoms of painful vesicular lesions, facial nerve palsy, and hearing loss. The patient was treated with oral acyclovir, dexamethasone, and supportive care. Significant improvement was noted by Day 7, with reduced pain, partial recovery of facial function, and improvement in hearing. By Day 14, all lesions had healed, and facial symmetry was restored. This case emphasizes the importance of early recognition and intervention in improving clinical outcomes in older patients with RHS.
拉姆齐·亨特综合征（RHS）是水痘-带状疱疹病毒（VZV）再激活引起的一种罕见并发症，通常表现为耳部疼痛性水疱性损害、面神经麻痹和听力丧失。早期诊断和抗病毒治疗对于将长期后遗症（如持续性面部无力和听力障碍）降至最低至关重要。本病例强调了在老年患者，尤其是那些已有听力困难的患者中及时识别和治疗的重要性。一名87岁女性，有2周的右耳和嘴唇疼痛性水疱样损害病史，伴有烧灼感。数天内，这些损害进展为可见的伤口。患者还报告了日益加重的无力、进食困难和听力障碍恶化。体格检查发现右耳廓和嘴唇有水疱性损害，右侧面部无力（House-Brackmann分级IV级），同侧轻度兔眼伴轻度结膜充血。未观察到新的水疱或全身性皮疹。患者的病史包括高血压和长期双侧听力困难。根据疼痛性水疱性损害、面神经麻痹和听力丧失的特征性症状诊断为拉姆齐·亨特综合征。患者接受了口服阿昔洛韦、地塞米松和支持性治疗。第7天观察到显著改善，疼痛减轻，面部功能部分恢复，听力改善。到第14天，所有损害均已愈合，面部对称性恢复。本病例强调了早期识别和干预对于改善老年RHS患者临床结局的重要性。
