Background: Herpes zoster oticus is a rare neurological disease caused by reactivation of varicella-zoster virus in the facial nerve.
Case presentation: A woman in her 60 s presented with left-sided seventh and eighth cranial neuropathy. A vesicular rash in her left ear and palate appeared one week after symptom onset. Lumbar puncture revealed cerebrospinal fluid (CSF) pleocytosis, mononuclear cells only, with PCR positive for varicella zoster virus. Inflammation of the cochlear and vestibular systems and along the facial nerve was detected by MRI. Antiviral treatment with valacyclovir in combination with prednisolone was initiated. After one month with outpatient rehabilitation, the vertigo had ceased, but hearing loss and facial paralysis persisted.
Interpretation: Early diagnosis and treatment of herpes zoster oticus as a cause of facial palsy when accompanied by ear rash, pain or signs of other cranial nerve involvement may improve overall prognosis.