Abstract
BACKGROUND: Ramsay Hunt syndrome is a form of acute herpes zoster caused by reactivation of the varicella-zoster virus in the geniculate ganglion. It presents with peripheral facial paralysis and characteristic vesicular lesions in the ear or oropharynx. This report highlights diagnostic challenges associated with delayed care. PATIENT INFORMATION: We describe a 67-year-old woman who had no prior medical history. She first reported increasing right ear pain two weeks ago, which was followed by fever, headache, and left-sided facial paralysis. The facial weakness was manifested by her being unable to completely close her left eye and the drooping of the left side. CLINICAL FINDINGS: The patient has a healed right auricular rash (see Figures 1 and 2) and Grade IV right facial paralysis. After ruling out other possible causes by CT and lab tests, a clinical diagnosis of Ramsay Hunt syndrome was made. INTERVENTION: While the patient came two weeks after the onset of symptoms, the key window for effective antiviral and corticosteroid therapy (usually within 72 hours) had already passed. As a result, these known treatments were not administered. The patient was given supportive treatment, which included eye drops to prevent corneal problems from incomplete eye closure and analgesics to control pain. OUTCOME: After a month, the patient demonstrated functional improvement, including improved mouth symmetry when smiling and full eye closure with little effort. Her facial nerve function was therefore classed as House-Brackmann Grade IV. This case highlights the long-term morbidity associated with RHS when immediate intervention is not possible. CONCLUSION: Despite being uncommon, Ramsay Hunt Syndrome requires a high level of suspicion from healthcare providers, particularly among patients who present with facial palsy along with vesicular rash and ear pain. To ensure prompt intervention and avoid long-term neurological consequences, early and precise diagnosis is crucial.