Ramsay Hunt Syndrome in an Immunocompetent 17-Years-Old Boy: A Case Report

Background: Ramsay-Hunt syndrome (RHS) is an uncommon complication of herpes zoster caused by the reactivation of the latent varicella-zoster virus (VZV) in the geniculate ganglion. It typically presents as a triad of ipsilateral facial paralysis, ear pain, and vesicular eruptions in the auditory canal or on the auricle. RHS can affect both immunocompetent and immunocompromised individuals, with an incidence of approximately 5 cases per 100,000 people annually. The incidence increases with age and is rarely observed in children. It is frequently reported in immunocompromised patients or individuals aged 50 years and older. Moreover, RHS is believed to account for up to 20% of clinically diagnosed Bell's palsy cases. Major risk factors for VZV reactivation include immunosuppression, advanced age, pregnancy, lack of varicella vaccination, and physical or psychological stress, which may lead to central nervous system involvement. Case presentation: A 17-year-old immunocompetent boy presented with multiple erythematous vesicles on the right side of his chin, lower lip, cheek, and slightly on the auricle, which appeared one day prior to examination. The lesions began with pain, burning sensations, and mild fever. Initially, the patient was diagnosed with herpes zoster involving the mandibular division (V3) of the trigeminal nerve. However, nine days after symptom onset, he developed right peripheral facial palsy, leading to a diagnosis of Ramsay Hunt syndrome with House. Treatment included a combination of antiviral medication, corticosteroids, and supportive care. The patient showed significant recovery within six weeks. Conclusion: Ramsay-Hunt syndrome is a rare complication of herpes zoster, commonly occurring in elderly and immunocompromised patients. Nonetheless, it can also manifest in younger individuals. Therefore, RHS should be also considered in the differential diagnosis when typical symptoms are present in young age population. Early diagnosis and initiation of treatment within 72 hours of symptom onset using antivirals and corticosteroids are essential for achieving optimal outcomes and minimizing long-term complications. Keywords: Ramsay-Hunt syndrome, Varicella zoster virus, young age, facial paralysis