Concurrent Ramsay Hunt syndrome and disseminated herpes zoster in a patient with relapsed chronic lymphocytic leukemia

Abstract

Ramsay Hunt Syndrome (RHS) is a rare complication of latent varicella-zoster virus (VZV) infection that can occur in immunocompetent host. It usually involves ipsilateral facial paralysis, ear pain and facial vesicles. Disseminated herpes zoster is another complication of VZV infection typically seen in immunocompromised hosts. We describe a patient with relapsed chronic lymphocytic leukemia (CLL) who presented simultaneously with RHS and disseminated herpes zoster. While other complications have been documented to coexist with RHS, to our knowledge, this is the first reported case in the literature of concurrent RHS with disseminated herpes zoster.

Keywords: CLL, chronic lymphocytic leukemia; CTCL, cutaneous T-cell lymphoma; Chronic lymphocytic leukemia; PCR, polymerase chain reaction; RHS, Ramsay Hunt syndrome; Ramsay Hunt syndrome; VZV, varicella-zoster virus; Varicella zoster virus.

Fig. 1

Varicella rash first seen in (a) left ear, followed by disseminated rash on (b) face, (c) legs, (d) chest, and (e) back.

Fig. 2

Cranial nerve deficits associated with Ramsay Hunt syndrome. Patient (a) trying to smile and raise eyebrows suffers from paralysis on left side, (b) trying to close both eyes but unable to fully close left eye, and (c) unable to abduct left eye past midline when looking to left.