Atypical Presentation of Ramsay Hunt Syndrome in an Immunocompromised Patient: A Case Report

Ramsay Hunt syndrome (RHS), or herpes zoster oticus, is a rare neurological complication of varicella-zoster virus reactivation within the geniculate ganglion, leading to unilateral facial pain, facial paralysis, otalgia, sensorineural hearing loss, and a painful vesicular rash on the face or ear. Reactivation of the virus most often affects the vestibulocochlear (cranial nerve eight) and facial (cranial nerve seven) nerves in RHS. Early recognition of RHS is important as delays in treatment can lead to permanent facial paralysis, scarring, or irreversible sensorineural hearing loss. In this case, we examine an 84-year-old immunocompromised female patient whose diagnosis of RHS was delayed by multiple medical comorbidities and an atypical initial presentation.