Ramsay Hunt Syndrome: a Pediatric Case

Background: Ramsay Hunt Syndrome (RHS) is characterized by peripheral facial palsy, periauricular pain, vesicular eruptions of the external canal and pinna and vestibulocochlear dysfunction. RHS is rare in children but it is the second most common cause of nontraumatic facial palsy in childhood. The diagnosis is primarily clinical and treatment is a combination of high-dose corticosteroids and acyclovir.

Case Report: A 13-year-old boy was admitted in the emergency room due to aggravation of right earache in the last five days, without fever. Seven days before he started treatment with amoxicillin and clavulanate for right acute media otitis. He was diagnosed with type 1 diabetes mellitus at 10 years of age and had varicella infection at 8 years old. The physical examination revealed: right auricular edema, pain at mastoid palpation and redness of ipsilateral eardrum at otoscopy. Few hours later, he developed a vesiculobullous rash on the right ear canal and on the right half of the palate in addition to a right peripheral facial palsy (House-Brackmann scale grade II) and vestibulocochlear symptoms (hearing loss and vertigo).

The complete blood count, the inflammatory markers and the computed tomography scan were normal. Pure tone audiogram confirmed a mild sensorineural hearing loss on the right side. The patient was hospitalized and started intravenous acyclovir (30mg/Kg/day), ceftriaxone (50mg/Kg/day) and prednisolone (60mg/day) for seven days. The prednisolone dose was tapered during the following two weeks. Facial physiotherapy and eye care were also prescribed. On discharge day, the audiogram was normal. The adolescent showed a complete recovery of facial nerve function within the 20 days after discharge.

Discussion: The authors want to emphasize the importance of careful examination and early initiation of therapy in suspected cases of RHS, which improves the recovery rate of the facial nerve palsy and have a positive effect on disease prognosis.