A Case of Lingual Zoster

A 72-year-old woman presented to the emergency department with white patches on the right side of her tongue and slight palsy on the right side of her face, reporting that the symptoms had developed 4 days earlier. She also reported dizziness, otalgia, nausea, and vomiting. She had no history of diabetes mellitus or immunosuppressive illnesses.

Examination of the tongue revealed multiple vesicles and pustules on the right side of the tongue and soft palate. Acyclovir was administered intravenously. Hearing loss in her right ear occurred 2 days later, and high-dose steroids were added to her treatment. A Tzank smear was positive, and a polymerase-chain-reaction assay performed with a vesicle specimen confirmed the presence of herpes zoster virus.

Ramsay Hunt syndrome occurs when herpes zoster reactivates in the facial nerve, causing facial palsy, otalgia, the development of vesicles in a dermatomal distribution, and occasional hearing loss.

Treatment typically consists of high-dose acyclovir. Her symptoms, save for the facial palsy, abated within 5 days. At follow-up of 4 months, the palsy remained but the function of the facial nerve improved, dropping from grade 4 to grade 2 on the House–Brackmann scale (with grade 1 indicating normal function).