From Ramsay Hunt to Parotid Cancer: A Case Report

Diagnosis of head and neck malignancies remains challenging given the complexity and heterogeneity of the organs and involved anatomical features. Additionally, the presenting symptoms of head and neck cancer may often be vague, mimicking symptoms of less serious illnesses. The following case highlights these challenges. The patient presented to his primary care physician with right facial paralysis involving difficulty closing his eye, as well as intermittent right ear pain. The patient was referred to neurology for a workup to diagnose Lyme Disease or Ramsay Hunt Auricularis. The patient was initially diagnosed with and treated for Ramsay Hunt Auricularis. Despite the treatment, the patient suffered two falls from a loss of consciousness. The cardiologist consulted in the emergency department noted no cardiac etiology. Ultimately, a Computerized Tomography scan and additional imaging revealed a parotid lesion, and the patient was diagnosed with salivary gland carcinoma. The tumor was encircling the internal carotid artery and was subsequently deemed inoperable. No distant metastases were noted. The patient was treated with concurrent chemoradiation using carboplatin and paclitaxel, and leuprolide for androgen receptor-positive cancer. The patient completed this treatment and continues leuprolide every three months. His most recent Positron Emission Tomography scan revealed no evidence of residual disease or recurrent/metastatic disease. The patient still experiences significant long-term treatment effects, such as lymphedema, trismus, and peripheral neuropathy, for which he undergoes rehabilitation services. This unique case is a prime example of the complicated diagnosis and treatment trajectories for patients with head and neck cancer. Frequent follow-up and long-term multidisciplinary care are essential to manage symptoms associated with treatment for all individuals with head and neck cancers.