Ramsay-Hunt syndrome: Report of two cases with identification of the varicella zoster virus genome in cerebrospinal fluid
Abstract
Like other alpha-herpesviruses, the varicella-zoster virus (VZV) remains latent in the neural ganglia following the primary varicella infection. The reactivation of the VZV in the dorsal root ganglia results in herpes zoster. Herpes zoster eruption is characterized by localized cutaneous lesions and neuralgic pain mostly in older and immunocompromised persons, especially those living with the human immunodeficiency virus (HIV).
The most commonly reported complications include VZV pneumonia, meningitis, encephalitis, and hepatitis. Several neurologic syndromes have been described associated with herpes zoster localized in cranial areas including peripheral nerve palsies and the Ramsay-Hunt syndrome, which has a varied clinical presentation and is the second most common cause of peripheral facial paralysis. Facial paralysis in this syndrome occurs in 60 to 90% of cases and it may precede or appear after the cutaneous lesions with a worse prognosis than idiopathic Bell paralysis.
Here we present two cases of herpes zoster from the geniculate ganglia with peripheral facial paralysis that appeared simultaneously with vesicular herpetic otic lesions (multimetameric Ramsay-Hunt syndrome). In the two cases, amplifiable varicella-zoster viral DNA was found in the cerebrospinal fluid by RT-PCR Multiplex.
Downloads
References
Ferrés M. Características de la familia Herpesviridae. En: Carballal G, Oubiña JR, editores. Virología médica. 4ª edición. Buenos Aires: Ed. Corpus; 2015. p. 394-5.
Ferrés M. Virus varicela zóster (VZV) (herpes virus humano 3). En: Carballal G, Oubiña JR, editores. Virología médica. 4ª edición. Buenos Aires: Ed. Corpus; 2015. p. 401-3.
Sweeney CJ, Tilden DH. Ramsay-Hunt syndrome. J Neurol Neurosurg Psychiatry. 2001;71:149-54.
Kuhweide R, van de Steene V, Vlaminck S, Casselman JW. Ramsay-Hunt syndrome: Pathophysiology of cochleovestibular symptoms. J Laryngol Otol. 2002;116:844-8. https://doi.org/10.1258/00222150260293691
Peitersen E. Bell’s palsy: The spontaneous course of 2500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl. 2002;594:4-30.
Martínez-Oviedo A, Lahoz-Zamarro MT, Uroz-del Hoyo JJ. Síndrome de Ramsay-Hunt. An Med Interna (Madrid). 2007;24:31-4.
Aviel A, Marsahak G. Ramsay-Hunt syndrome: A cranial polyneuropathy. Am J Otolaryngol. 1982;3:61-6. https://doi.org/10.1016/s0196-0709(82)80035-5
Murukami S, Honda N, Mizobuchi M, Nakashiro Y, Hato N, Gyo K. Rapid diagnosis of varicella zoster virus infection in acute facial palsy. Neurology. 1998;51:1202-5. https://doi.org/10.1212/wnl.51.4.1202
Morow MJ. Bell’s palsy and herpes zoster oticus. Curr Treat Options Neurol. 2000;2:407-16. https://doi.org/10.1007/s11940-000-0039-5
Orgaz-Gallego MP, Curbelo-del Bosque JM, Tricio-Armero MA, Pérez-Sánchez S. Síndrome de Ramsay Hunt. A propósito de un caso. Rev Clin Med Fam. 2016;9:119-22.
Bianchi M, Santiso G, Lehmann E, Walker L, Arechavala A, Maiolo E, et al. Utilidad del citodiagnóstico de Tzanck en un hospital de enfermedades infecciosas de la ciudad de Buenos Aires. Dermatol Argent. 2012;18:42-6.
Bhupal HK. Ramsay Hunt syndrome presenting in primary care. Practitioner. 2010;254:33-53.
Coulson S, Croxson GR, Adams R, Oey V. Prognostic factors in herpes zoster oticus (Ramsay Hunt Syndrome). Otol Neurotol. 2011;32:1025-30. https://doi.org/10.1097/MAO.0b013e3182255727
Hilt DC, Buchholz D, Drumholz A, Weiss H, Wolinsky JS. Herpes zoster ophthalmicus and delayed contralateral hemiparesis caused by cerebral angiitis: Diagnosis and management approaches. Ann Neurol. 1983;14:543-53. https://doi.org/10.1002/ana.410140509
Metta HA, Mammana L, Redini L, Bruggesser F, Bouzas MB. Difficulties in the diagnosis of delayed contralateral hemiparesis due to varicella-zoster virus in an HIV-positive patient. Int J Infect Dis. 2009;13:e329-30. https://doi.org/10.1016/j.ijid.2008.12.006
Gilden DH, Kleinschmidt-De Masters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ. Neurologic complications of the reactivation of varicela-zoster virus. N Engl J Med. 2000;342:635-45. https://doi.org/10.1056/NEJM200003023420906
Corti M, Trione N, Villafañe MF, Risso D, Yampolsky C, Mamanna L. Acute meningoencephalomyelitis due to varicella-zoster virus in an AIDS patient: Report of a case and review of the literature. Rev Soc Bras Med Trop. 2011;44:784-6. https://doi.org/10.1590/s0037-86822011000600026
Corti M, Villafañe MF, Vittar N, Banco MC, Priarone M, Mamanna L, et al. Meningoencephalitis due to varicela zoster virus in AIDS patients. Report of eleven cases and review of the literature. Rev Inst Med Trop Sao Paulo. 2015;57:505-8. https://doi.org/10.1590/S0036-46652015000600007
Some similar items:
- Lina Ruiz, María Angélica Maya, Zulma Vanesa Rueda, Lucelly López, Lázaro Agustín Vélez, Current characteristics of tuberculosis and human immunodeficiency virus co-infection in a cohort of hospitalized patients in Medellín, Colombia , Biomedica: Vol. 38 No. Sup. 2 (2018): Suplemento 2, Medicina tropical
- María Patricia Arbeláez, Alexánder Arbeláez, Rubén Darío Gómez, Carlos Rojas, Lázaro Vélez, Sonia Luz Arias, Jorge Nagles, Luz Marina Peláez, Gloria Betancourt, Gloria Velásquez, Effectiveness of prophylaxis against tuberculosis in patients infected with HIV , Biomedica: Vol. 27 No. 4 (2007)
- María Teresa Rugeles, Paula A. Velilla, Carlos J. Montoya, Mechanisms of human natural resistance to HIV: A summary of ten years of research in the Colombian population , Biomedica: Vol. 31 No. 2 (2011)
- Jaiberth Cardona-Arias, Luz Peláez-Vanegas, Juan López-Saldarriaga, Marcela Duque-Molina, Oscar Leal-Álvarez, Health related quality of life in adults with HIV/AIDS in Colombia , Biomedica: Vol. 31 No. 4 (2011)
- Jorge Andrés Potosí, Yina Marcela Gutiérrez, Fabiola Eugenia González, The relevance of clinical and epidemiological correlation in the early diagnosis of histoplasmosis: report of two clinical cases in Popayán, Colombia , Biomedica: Vol. 43 No. Sp. 1 (2023): Agosto, Micología médica
- Ana María Sanín , Ángela María Londoño , Verónica Gil , Ana María Mejía , Hernán Darío Aguirre, Elsa María Vásquez , Catalina Valencia , Carolina Cardona, Mucocutaneous manifestations and their relationship with CD4 T-lymphocyte count in hospitalized patients infected with the human immunodeficiency virus (HIV) in Medellín, Colombia , Biomedica: Vol. 42 No. 2 (2022)
- Ana Luz Galván-Díaz, Juan Carlos Alzate, Esteban Villegas, Sofía Giraldo, Jorge Botero, Gisela García, Chronic Cystoisospora belli infection in a Colombian patient living with HIV and poor adherence to highly active antiretroviral therapy , Biomedica: Vol. 41 No. Supl. 1 (2021): Mayo, Parasitología médica
- Zulbey Rivero-Rodríguez, Amparo Hernández, Ángela Bracho, Solneumar Salazar, Rafael Villalobos, Prevalence of intestinal microsporidia and other intestinal parasites in HIV positive patients of Maracaibo, Venezuela , Biomedica: Vol. 33 No. 4 (2013)
- Sunny Sánchez, Dolores Zambrano, Maylen García, César Bedoya, Carlos Fernández, María Teresa Illnait-Zaragozí, Molecular characterization of Cryptococcus neoformans isolates from HIV patients, Guayaquil, Ecuador , Biomedica: Vol. 37 No. 3 (2017)
- Leonardo F. Jurado, Martha I. Murcia, Patricia Hidalgo, John E. Leguizamón, Lorena R. González, Phenotypic and genotypic diagnosis of bone and miliary tuberculosis in an HIV+ patient in Bogotá, Colombia , Biomedica: Vol. 35 No. 1 (2015)
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
