Sažetak sa skupa
Ramsay Hunt syndrom sine herpete
Luka Blažević
; KB Sveti Duh, Ulica Sveti Duh 64, 10000 Zagreb, Hrvatska
Tereza Cvjetko
; KB Sveti Duh, Ulica Sveti Duh 64, 10000 Zagreb, Hrvatska
Tena Šimunjak
; KB Sveti Duh, Ulica Sveti Duh 64, 10000 Zagreb, Hrvatska
Ivan Mesar
; KB Sveti Duh, Ulica Sveti Duh 64, 10000 Zagreb, Hrvatska
Marica Žižić
; KB Sveti Duh, Ulica Sveti Duh 64, 10000 Zagreb, Hrvatska; Fakultet dentalne mediciine i zdravstva Sveučilišta Josipa Jurja Strossmayera Osijek, Crkvena ulica 21, 31000 Osijek, Hrvatska
Boris Šimunjak
; KB Sveti Duh, Ulica Sveti Duh 64, 10000 Zagreb, Hrvatska; Fakultet dentalne mediciine i zdravstva Sveučilišta Josipa Jurja Strossmayera Osijek, Crkvena ulica 21, 31000 Osijek, Hrvatska
Sažetak
Introduction: Herpes zoster oticus, or Ramsay Hunt syndrome, is an infection caused by Varicella zoster virus
(VZV). The disease occurs due to the reactivation of VZV in the geniculate ganglion of the seventh cranial
nerve, with possible spreading to the eighth and, in rare cases, the ninth and tenth cranial nerves. Vesicular
rash on the auricle and external auditory canal, ipsilateral facial nerve palsy, and otalgia constitute the classic
Ramsay Hunt triad. Additional symptoms often include sensorineural hearing loss and vestibular disturbances.
We present the case of a patient with an atypical form of the disease without characteristic vesicles, known as
herpes zoster sine herpete. Case report: A 52-year-old male presented to the Emergency ENT Clinic with
rotatory vertigo, nausea, right ear pain, and weakness on the right side of the face, preventing him from closing
his eye. The patient also reported pre-existing right-sided hearing loss. The clinical examination revealed a
normal bilateral otoscopy and no skin changes in the auricle or external auditory canal. The patient exhibited
a left-beating rotatory nystagmus grade II according to Alexander, and the Head Impulse Test (HIT) was
positive on the right side, suggesting vestibular neuritis. Additionally, there was right-sided peripheral facial
nerve palsy grade III on the House-Brackmann scale. Inflammatory markers were normal, and an urgent brain
MSCT revealed no acute lesions. Peripheral neuritis of the right vestibular nerve was confirmed by vHIT,
which showed reduced gains on the right side: DP 0.60, DA 0.32, DL 0.46, LP 0.76, LA 0.77, LL 0.81. Pure
tone audiometry (PTA) revealed normal hearing up to 2 kHz, with bilateral sensorineural hearing loss in high
frequencies up to 60 dB. Serological testing confirmed the presence of VZV-specific IgM antibodies,
establishing the diagnosis of herpes zoster sine herpete. The patient was treated with acyclovir in combination
with high-dose corticosteroids and was discharged after several days following clinical improvement.
Conclusion: Herpes zoster sine herpete is an atypical form of the Ramsay Hunt syndrome without vesicular
rash. It should be considered in cases of peripheral facial palsy accompanied by ear pain or vestibular
symptoms, as early treatment is crucial for the best possible outcome.
Ključne riječi
facial palsy; herpes zoster sine herpete; Ramsay Hunt syndrome
Hrčak ID:
336280
URI
Datum izdavanja:
10.11.2025.
Posjeta: 152 *