Herpes Zoster Cephalicus: A Rare Case Report.

Abstract

Herpes Zoster Cephalicus (HZC) is a rare clinical presentation of Varicella Zoster Virus (VZV) reactivation that involves the cranial nerves and extends to the pharynx and larynx. This case report describes an unusual case of a 52-year-old male who developed right-sided earache, facial weakness, odynophagia, hoarseness of voice and slurred speech. Physical examination revealed vesicular eruptions in the right external ear and tympanic membrane along with Grade VI facial palsy. Neurological signs included palatal palsy with uvular deviation and right vocal cord immobility. Audiological assessment showed sensorineural hearing loss on the affected side. Laryngoscopy demonstrated vesicular lesions in the supraglottic region and pooling of saliva in the right pyriform sinus. These findings pointed toward the involvement of cranial nerves VII (facial), VIII (vestibulocochlear), IX (glossopharyngeal) and X (vagus). The patient was treated promptly with high-dose oral acyclovir and corticosteroids initially intravenous betamethasone followed by a tapering oral prednisolone regimen. Additional supportive care included analgesics, neuroprotective and eye care. Over the course of five weeks the patient experienced significant clinical improvement with recovery of facial nerve function and normalization of vocal cord movement. This case emphasizes the importance of early clinical recognition of HZC particularly in cases with multiple cranial neuropathies and rare pharyngolaryngeal involvement. In the absence of advanced viral diagnostics, combination of clinical features and endoscopic findings remains critical for diagnosis. Early antiviral and corticosteroid therapy can facilitate recovery and prevent long-term complications in such rare but serious cases.