Disseminated herpes zoster in an immunocompetent young adult: A rare complication of Ramsay Hunt syndrome

Ramsay Hunt syndrome (RHS) is a complication of latent varicella-zoster virus infection, and is considered as a form of herpes zoster (HZ) occurring in the otic region. Although skin lesions of HZ usually appear along only one or two dermatomes, it is occasionally disseminated in patients with decreased immunity. Here we report a rare case of RHS developing disseminated herpes zoster in an immunocompetent young adult. A 16-year-old healthy man complained of left-sided facial weakness accompanied with otalgia, vesicles on the left ear, hearing loss, and vertigo. Although famciclovir and prednisolone was administered, his symptoms progressed and was hospitalized. Rashes all over the body developed, and dermatologist diagnosed a disseminated herpes zoster infection. Quarantine was commanded to prevent airborne transmission, and the administration of antiviral drug and steroid was continued. The patient recovered without sequelae. The important learning point of this case is discrimination from drug eruption for clinical decision-making.

Automated summary

Ramsay Hunt syndrome (RHS) is a rare complication of latent varicella-zoster virus infection, and this case reports a unique occurrence of disseminated herpes zoster in an immunocompetent young adult with RHS. The patient presented with left-sided facial weakness, otalgia, vesicles on the left ear, hearing loss, and vertigo. Despite treatment with famciclovir and prednisolone, the symptoms worsened and the patient was diagnosed with disseminated herpes zoster. The importance of differentiating drug eruption for appropriate clinical decision-making is emphasized.