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Varicella-zoster virus reactivation in the facial nerve caused a 57-year-old man to experience facial pain, swelling, hearing loss, and a rash. Prompt treatment with acyclovir and prednisone led to rapid symptom improvement.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Dermatology

Background:

  • Varicella-zoster virus (VZV) reactivation, commonly known as shingles, typically affects the cranial nerves.
  • Reactivation in the geniculate ganglion or facial nerve (cranial nerve VII) is a rare but recognized cause of specific neurological and dermatological symptoms.

Observation:

  • A 57-year-old male presented with acute onset of left-sided facial pain, swelling, and ipsilateral hearing loss.
  • The patient subsequently developed a painful, unilateral vesicular rash affecting the anterior two-thirds of the tongue, external auditory canal, lip, and face.

Findings:

  • The clinical presentation was characteristic of VZV reactivation involving the facial nerve, a condition historically described by Hunt.
  • Diagnosis was confirmed by the typical clinical manifestations of VZV reactivation.

Implications:

  • This case highlights the importance of recognizing atypical VZV reactivation patterns affecting the facial nerve.
  • Early diagnosis and treatment with antiviral therapy (acyclovir) and corticosteroids (prednisone) are crucial for favorable outcomes, including pain relief and resolution of lesions.
  • Prompt management can lead to significant improvement in symptoms such as hearing loss and facial nerve dysfunction.