Case report: Vocal cord paresis due to zoster radiculitis after covid-19 infection

Introduction Varicella zoster virus (VZV), persisting in cranial nerves as well as spinal ganglia, is usually reactivated in immunodeficiency and causes pathognomonic vesicular efflorescences, pain, and possibly neurologic deficits, depending on the affected nerve roots. Rarely, the vagus nerve is affected.

Case report The 37-year-old patient presented himself with persistent dysphonia, dysphagia, and additonally new onset of otalgia on the right side without hearing loss or vertigo. Initially, a diagnosis of acute superinfected laryngopharyngitis was suspected shortly after covid-19 infection. The initiated oral antibiotic therapy did not bring improvement. Clinically, there was a reddened cavum conchae and tympanic membrane with crusty vesicular efflorescences, furthermore similar efflorescences in the area of the arytenoid cartilage as well as vocal cord paresis, additionally a paresis of the trapezius muscle and MSCM on the right side. The remaining cranial nerves were symmetrically intact. The diagnosis of a polyradiculitis with affection of the right vagus nerve as well as the right accessorius nerve was suspected. Due to pleocytosis in the cerebrospinal fluid, empirical intravenous therapy with aciclovir 10mg/Kg of body weight i.v. 3x daily was supplemented with ceftriaxone 2g 1x daily and reduced to virostatic therapy after varicella zoster infection was confirmed in the cerebrospinal fluid as well as in the swap sample. This treatment showed a rapid regression of the symptoms.

Conclusion  Antiviral i.v. therapy remains significant. The previous Covid-19 infection has to be discussed as a trigger. VZV infection must be considered as a differential diagnosis of laryngopharyngitis, especially in the absence of improvement and clinical signs of nerval affection.

Publication History

Article published online:
12 May 2023