Clinical Insights Into Ramsay Hunt Syndrome - A Case Report Highlighting Diagnostic Challengesand Management Considerations

Sep 29, 2026

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Ramsay Hunt syndrome is an acute herpes zoster entity driven by varicella-zoster virus reactivation in the geniculate ganglion, classically producing ipsilateral facial paralysis with vesicular ear or oropharyngeal lesions. This case report describes a 67-year-old woman whose symptoms began with progressive right ear pain, fever, headache, and subsequent left-sided facial paralysis and vesicular eruptions. Delayed presentation meant antiviral and corticosteroid therapy within 72 hours could not be delivered. Supportive care enabled functional recovery after one month, underscoring the need for prompt, precise diagnosis when the typical symptom triad is not concurrent.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Background

Patient Information

Clinical Findings

Intervention

Outcome

Conclusion

Introduction

Epidemiology and Typical Presentation

Importance of Early Therapy

Case Presentation

International Medical Case Reports Journal Open Access Full Text Article C ASE REPORT Clinical Insights Into Ramsay Hunt Syndrome: A Case Report Highlighting Diagnostic Challengesand Management Considerations Hamza Abdiaziz Osman 1 , Abdalla Ahmed Deifa 1 , Mutaz Ali 1 , 2 1Internal Medicine, Faculty of Clinical Medicine and Dentistry, Kampala International University, KIU Teaching and Research Hospital, Ishaka, Bushenyi, Uganda; 2Faculty of Medicine and Surgery, Salaam University, Mogadishu, Somalia Correspondence: Hamza Abdiaziz Osman, Email [hamaza2k@gmail.com](hamaza2k@gmail.com) | Background: Ramsay Hunt syndrome is a form of acute herpes zoster caused by reactivation of the varicella-zoster virus in the geniculate ganglion. It presents with peripheral facial paralysis and characteristic vesicular lesions in the ear or oropharynx. This report highlights diagnostic challenges associated with delayed care.
Patient Information: We describe a 67-year-old woman who had no prior medical history. She first reported increasing right ear pain two weeks ago, which was followed by fever, headache, and left-sided facial paralysis. The facial weakness was manifested by her being unable to completely close her left eye and the drooping of the left side.
Clinical Findings: The patient has a healed right auricular rash (see Figures 1 and 2) and Grade IV right facial paralysis. After ruling out other possible causes by CT and lab tests, a clinical diagnosis of Ramsay Hunt syndrome was made.
Intervention: While the patient came two weeks after the onset of symptoms, the key window for effective antiviral and corticosteroid therapy (usually within 72 hours) had already passed. As a result, these known treatments were not administered. The patient was given supportive treatment, which included eye drops to prevent corneal problems from incomplete eye closure and analgesics to control pain.
Outcome: After a month, the patient demonstrated functional improvement, including improved mouth symmetry when smiling and full eye closure with little effort. Her facial nerve function was therefore classed as House–Brackmann Grade IV. This case highlights the long-term morbidity associated with RHS when immediate intervention is not possible.
Conclusion: Despite being uncommon, Ramsay Hunt Syndrome requires a high level of suspicion from healthcare providers, particularly among patients who present with facial palsy along with vesicular rash and ear pain. To ensure prompt intervention and avoid long-term neurological consequences, early and precise diagnosis is crucial.
Keywords: Ramsay Hunt Syndrome, RHS, herpes zoster oticus, corticosteroids, antivirals, Varicella-Zoster virus, VZV, LMN (lower motor neuron) palsy | | --- | | Introduction
Ramsay Hunt Syndrome is a neurological condition caused by the reactivation of the varicella-zoster virus (VZV) in the facial nerve’s geniculate ganglion (cranial nerve VII) .1 Vesicular eruptions in the mouth or ear, ear pain, and facial paralysis on the afflicted side are typical manifestations.2 Although the facial nerve is usually the most affected, other cranial nerves, such as the vestibulocochlear (VIII), glossopharyngeal (IX), trigeminal (V), and abducens (VI), may also be affected.3
According to estimates, there are approximately 5 cases of RHS per 100,000 people per year, including both immunocompetent and immunocompromised patients.4
Improving patient outcomes and reducing long-term consequences depend on early diagnosis and timely antiviral and corticosteroid therapy, ideally within 72 hours after symptom onset.4 Meanwhile, diagnostic difficulties might develop when the usual triad of symptoms does not appear concurrently, or when patients seek health care outside of this critical | Received: 13 August 2025 Accepted: 23 December 2025 Published: 31 December 2025 International Medical Case Reports Journal 2025:18 1709–1713 1709 © 2025 Osman et al. This work is

FAQs

What causes Ramsay Hunt syndrome and what are its typical clinical signs?

Ramsay Hunt syndrome results from reactivation of the varicella-zoster virus in the geniculate ganglion. It typically presents with ipsilateral peripheral facial paralysis plus vesicular lesions in the ear or oropharynx and ear pain.

Why were antiviral and corticosteroid treatments not administered in this case?

The patient presented two weeks after symptom onset, so the effective treatment window (usually within 72 hours) had already passed.

What was the outcome after one month and what grading was used?

After one month, the patient showed functional improvement including improved mouth symmetry and full eye closure with little effort. Facial nerve function was classified as House–Brackmann Grade IV.

Sep 29, 2026

Uploaded by Aurelia