A Case Report of Infantile Ramsay Hunt Syndrome
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CLINICAL REPORT
A Case Report of Infantile Ramsay Hunt Syndrome Shivesh Maharaj1,2
Received: 28 June 2020 / Accepted: 15 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract Ramsay Hunt Syndrome is a rare condition in children. There are currently no internationally accepted protocols in the management of these patients. We present a case of a 9 month old child that presented to our Department with Ramsay Hunt syndrome. Included is the management of the clinical condition and a brief literature review. Early identification, a high index of suspicion and prompt treatment is required to achieve a good clinical outcome. Keywords Ramsay hunt Infant Cellulitis
The first documented case was reported in a 3 month old by Balatsouras et al. [6]. We present a case of a 9 month old child that developed Ramsay Hunt Syndrome and associated facial cellulitis. We include our management as well as a brief review of the relevant literature. A search of all articles reporting Ramsay Hunt Syndrome in infants, was performed using the PubMed, Medline, and Cochrane Review Databases, from inception until March, 30 2020. The detailed keywords used for the search were as follows: ‘‘Infant’’, ‘‘Ramsay Hunt Syndrome’’, ‘‘Herpes Zoster Oticus’’.
Background Lower motor neuron facial nerve palsy in children may be congenital or acquired. The majority of these may be classified as Bell’s palsy however there have been cases reported of pediatric Ramsay Hunt Syndrome (RHS) [1]. Ramsay Hunt was the first to propose that the Varicella Zoster Viral infection of the geniculate ganglion was responsible for the clinical syndrome consisting of facial nerve paralysis, hearing and balance dysfunction, with a herpetic skin rash involving the auricle and thus coined the term ‘‘herpes zoster oticus’’[2–4]. The reported incidence is 2.7/100,000 children [5].
& Shivesh Maharaj [email protected] 1
Department of Otorhinolaryngology, University of the Witwatersrand, Johannesburg, South Africa
2
Department of ENT, University of the Witwatersrand, Johannesburg, South Africa
Case Presentation A 9 month old child was referred to the Otorhinolaryngology department at the Charlotte Maxeke Johannesburg Academic Hospital by the pediatric department, with a one week history of having chicken pox. The child was not vaccinated against chicken pox. There was no history of Zoster infection reported by the mother during her pregnancy, and for the following 9 months after the baby was born. Upon further clinical enquiry it was found that the child had vesicles on the right ear that had burst open. The mother also noticed a discharge from the right ear and associated swelling over the ear that was progressively getting worse. There was also a swelling on the right side of the face. The right external ear canal was swollen and on initial examination it was difficult to visualise the tympanic membrane. Vesicles were noted on the Right pinna (Fig. 1).
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Indian J Otolaryngol Head Neck Surg
deemed as pass, and the left referred due to t
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