Herpes Zoster of the Larynx: A Diagnostic and Therapeutic Challenge

Herpes zoster of the larynx is an exceptionally rare condition that may mimic more common causes of laryngitis. Reactivation of varicella-zoster virus in the vagus nerve can lead to odynophagia, dysphonia, and dysphagia, often without the typical cutaneous rash. Early recognition is essential, as delayed diagnosis may result in serious complications, including postherpetic neuralgia, persistent dysphagia, chronic voice impairment, and even laryngeal paralysis. We describe a 66-year-old woman on long-term low-dose corticosteroid therapy who presented with acute odynophagia, dysphagia, dysphonia, and fever. Flexible nasopharyngolaryngoscopy revealed supraglottic vesicles localized to the right hemilarynx, extending to the epiglottis and arytenoid region, with ipsilateral sensory loss. Serological testing confirmed varicella-zoster virus infection. The patient was treated with valacyclovir and gabapentin, with resolution of odynophagia and mucosal lesions at one month, though mild dysphagia persisted. Laryngeal herpes zoster represents a diagnostic challenge due to its rarity, overlapping symptoms with other forms of laryngitis, and the brief window of opportunity in which vesicular lesions are visible. The scarcity of reported cases underscores the importance of maintaining a high index of suspicion, particularly in immunosuppressed patients. Early antiviral therapy is crucial to reduce complications, while endoscopic evaluation plays a key role in timely recognition.