Case Report: Herpes Zoster Cephalicus in an Immunocompromised Patient

Introduction Ear–nose–throat–head and neck manifestations due to HIV infection are common in otolaryngological practice. We would like to present a case of herpes zoster cephalicus in a middle-aged lady who was HIV positive.

Case Presentation A 38-year-old lady presented to us with complete weakness of left side of the face, otalgia, nasal regurgitation of fluids during swallowing and dysphagia. ENT examination revealed dried hemorrhagic crusts along the sensory distribution of the facial nerve in the left ear with left-sided lower motor neuron type of facial paralysis, House–Brackmann grade IV. A horizontal paralytic type of nystagmus to the right was present. Throat examination revealed ipsilateral paralysis of the soft palate. Laryngo-endoscopy revealed left-sided vocal cord palsy. A clinical diagnosis of herpes zoster cephalicus was made and treatment was started with oral acyclovir and prednisolone after consultation with an internist. The patient made a partial recovery.

Discussion Herpes zoster cephalicus is an uncommon clinical syndrome seen in immunocompromised patients which occurs due to reactivation of herpes zoster virus dormant in the involved cranial nerve ganglia of head and neck. Patients present to us with acute onset of facial nerve palsy with otalgia with vesicles seen in the sensory distribution of the facial nerve, absence of pharyngeal reflexes, paralysis of palate, and vocal cord. Some patients may also have labyrinthine involvement. Then, patients should be aggressively treated with acyclovir and steroids along with antiretroviral therapy.

Conclusion Immunocompromised patients having multiple lower cranial nerve palsies of head and neck should be suspected to have herpes zoster cephalicus. These patients should be aggressively treated to prevent unwanted permanent motor deficits.