Herpes Zoster Oticus in A 12 Year Old Child and Review of Literature - A Case
Herpes Zoster Oticus in A 12 Year Old Child and Review of Literature - A Case
12, 1-5
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Herpes Zoster Oticus in a 12 Year Old Child and Review of Literature - A Case
Report
Menon Narayanankutty Sunilkumar , Narendran Gayathrivarma, Vadakut Krishnan Parvathy
Amala Institute of Medical Sciences, Amala Nagar, Kerala, India
Corresponding author email: [email protected]
International Journal of Clinical Case Reports, 2015, Vol.5, No.12 doi: 10.5376/ijccr.2015.05.0012
Received: 4 Dec., 2014
Accepted: 4 Jan., 2015
Published: 28 Feb., 2015
Copyright 2015 Sunilkumar et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Sunilkumar et al., 2015, Herpes Zoster Oticus in a 12 year old child and review of literature - A case report, International Journal of Clinical Case Reports,
Vol.5, No. 12 1-3 (doi: 10.5376/ijccr.2015.05.0012)
Abstract The enigma of Ramsay Hunt syndrome is that it is an association of an acute peripheral facial neuropathy and herpetic
vesicular rash of the skin of the ear canal, auricle (Herpes Zoster Oticus) and/or mucous membrane of the mouth. Paediatricians see
many children with vesiculous eruptions over the face and the body. A combination of otalgia and cutaneous / mucosal eruptions is
not very uncommon in these children. Facial palsy can result if a proper history of a varicella zoster infection is not identified,
diagnosed with delay and if appropriate measures not taken in such a child. In this case study, we report 12 year-old boy who
presented with Herpes Zoster Oticus.
Keywords Ramsay Hunt Syndrome; Herpes Zoster Oticus; Varicella-Zoster Virus; Facial Nerve Palsy; Acyclovir
aspect of the tongue. Central nervous system and urine culture sensitivity results were normal
examination revealed only pain in the area of the (Table 1).
vesicles on the right side of the face, there was
excessive tears from the right eye, pain and tingling Patient was given symptomatic treatment for his fever
sensation in the right side of the face along the and pain with paracetamol and treated with Acyclovir
vesicular lesions, mild difficulty in clenching the teeth (400 mg tablet, 1 tablets 6th hourly), co-amoxyclav
and fortunately no other severe features of facial nerve intravenously (30 mg /kg/dose) 3 times/day along with
palsy such as facial asymmetry and the House-Brackmann metrogyl intravenously (7.5 mg/kg/dose) in 3
facial nerve grading system was found to be grade 1 (ie times/day for treating secondary infection of the
normal facial function in all areas). There was no dysarthria, vesicles and the cellulitis, silver sulfadiazine ointment
gait ataxia or hearing loss. He was conscious and oriented local application over the lesions, proper hydration as
signs of meningeal irritation were absent. Systemic
he was very much lethargic for the first 3 days.
examination was normal.
Routine eye care was given like artificial tear drops
Dermatologist evaluation was done for the child. and antibiotic eye drops. His skin lesions resolved in
Tzanck smear showed giant cells. Ear Nose and one week. Patient was discharged after full treatment
Throat specialists evaluation revealed tympanic of 7 days with acyclovir. He was followed-up and is
membranes intact in both ears and the right ear lobe doing well for the last 4 months.
was erythematic appearance, vesicles extending to
external auditory canal and positional vertigo ruled
out. Ophthalmology evaluation showed congested
right eye and there were no vesicles in the eye and
cornea appeared clear. Diagnosis of HZO and
prevention of the RHS was made based on the history
of varicella infection in the past and the clinical
presentation now. Without undue delay on the same
day itself appropriate treatment was started.
Laboratory investigations such as Hemogram, urine
routine, serum electrolytes, Serum Glutamic Pyruvate
Figure 1-Child on admission with the characteristic herpetic
Transaminase (SGPT), peripheral blood smear, blood
blisters in the right side of the face-Herpetic Zoster Oticus
Table 1 Laboratory investigations
Sl Investigations Biological reference values
1 Hematological Hb:13.7 g/dl, Hb: 12-14 g/dl,
PCV:33.7%, PCV: 30-42 %,
Total count:7600/ul, Total count:4000-10000/ul, neutrophils:40-55 %,
neutrophils:50 %, Lymphocytes: 28-48%,
Lymphocytes:45%, Eosinophils:2%, Eosinophils: 1-5%,
Monocytes: 3 %, Monocytes: 3-6%,
Basophils: 0%, Basophils: 0-1%,
ESR: 20mm/hr, ESR: 22 mm/hr,
Platelets;285000/ul Platelets; 150000-400000/ul
2 Urine routine Albumin: nil,
sugar-:nil,
pus cells:1-2/hpf, epithelial cells:+/hpf,
bile salt & bile pigment: negative
3 Serum electrolytes, Serum sodium 137 mmol/L, Serum sodium 135-145 mmol/L
Potassium: 4.3 mmol/L, Potassium: 3.5-4.5 mmol/L,
Bicarbonate: 25 mmol/L, Bicarbonate: 24-28 mmol/L
Chloride: 102 mmol/L Chloride: 96-105 mmol/L
4 Serum Glutamic Serum SGPT: 35U/L Serum SGPT < 45U/L
Pyruvate
Transaminase
(SGPT)
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diagnostic test .It has a specificity of 100% but is not Yilmaz, 2012). Hearing loss usually recovers well.
always feasible. Tzanck test was done in our case and Age of the patient and other co-existing illness has
has significance to identify the etiology poor prognostic features (Yeo et al., 2007).
(Durdu et al., 2008). VZV antigen detection by direct The prognosis of the facial paralysis in HZO/RHS is
immunofluorescence assay has a sensitivity of 90% worse than that in Bell's palsy, and only 10% of
and specificity 99% (Coffin and Hodinka, 1995). In complete facial paralysis in RHS recovers completely
our case a tzanck smear and timely clinical diagnosis (Muecke and Amedee, 1993; Yeo et al., 2006).
was made and treatment started.
HZO caused by VZV reactivation can result in the rare
Antiviral agents are effective in reducing the severity RHS in children. So a child with HZO is vulnerable to
and duration of acute herpes zoster and HZO perse progress to RHS, if not diagnosed immediately and
when given within 72 hours of rash onset. Moderate timely treatment started. Physician education is vital
pain relief can be achieved with anticonvulsants, in detecting HZO/RHS at very early stage as it can be
tricyclic antidepressants, opioids, and topical a rare cause of facial palsy in young children and
treatment modalities such as lidocaine-containing thereby prevent the associated morbidity.
patches and capsaicin cream (Galluzzi, 2007).
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