Wednesday, November 19, 2014

Spot Diagnosis # 5

A 70 years old male presented with earache deep inside the left ear radiating to pinna. On examination, his left external canal and pinna showed vesicular rashes with drooping left side of the mouth.  What is your spot diagnosis?

The diagnosis is Ramsay Hunt Syndrome (RHS). It is a reactivation syndrome of herpes zoster virus in an L-shaped ganglion of facial nerve named  as geniculate ganglion, present in facial canal. RHS occurs when herpes zoster virus infects facial nerve and presents with painful shingle rash with fluid filled vesicles seen on, in or around the single ear. It may present with ear pain, hearing loss, ringing of ear, difficulty in closing the eye on the affected side as well as vertigo, change in taste and facial paralysis. All the signs and symptom described in the scenario above support the diagnosis of Ramsay Hunt Syndrome or herpes zoster oticus.
Keywords: Earache, Vesicular rash, Drooping mouth, Ramsay Hunt Syndrome or herpes zoster oticus

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