Ramsay Hunt syndrome presenting as “a window'' to HIV diagnosis in 48 year old African female: A case report

Abstract

Ramsay Hunt syndrome in adults is reported in a number of case reports as an uncommon presentation of Varicella - zoster Virus infection. Ramsay Hunt syndrome occurs when there is reactivation of the latent Varicella - zoster virus present in the ganglia due to previous varicella infection. Following a breakdown of the immune system, latent Varicella - zoster infection can be activated. Human Immunodeficiency Virus infection (HIV), causes immunosuppression and hence reactivation of Varicella - zoster. The diagnosis of Ramsay Hunt syndrome, gives a window of opportunity to investigate for HIV. Here we report our first case of Ramsay Hunt syndrome as a presenting feature of HIV disease in an apparently healthy looking 48 year old black African female who was unaware of her HIV status at the time of presentation. This case is reported in order to highlight the need to use Ramsay Hunt syndrome as a window of opportunity to screen for underlying HIV. Case presentation: A 48 year old black African female who was unaware of her HIV status, presented to our outpatients department with a two day history of painful right ear pain, vesicles on the right pinna and inability to completely close her right eye, her mouth was deviated to the left, with a wrinkle free frown. She denied any alteration in taste sensation and hyperacusis. She had a grade IV House-Brackmann facial paralysis. A diagnosis of Ramsay Hunt syndrome was made and an HIV test was offered, the test was positive for HIV. A subsequent Highly Active Antiretroviral Therapy (HAART) work up, revealed Chronic Kidney Disease stage 3B (CKD 3B) and a cluster of differentiation 4(CD4) count of 217 cells/µl. She was started on antiretroviral therapy 2 weeks after completing a 10 day regimen of acyclovir. In addition to her drug treatment she received ocular care and physiotherapy. Four months on her facial nerve function has improved modestly. An HIV test should be an indispensable part of the Ramsay Hunt syndrome workup, as its diagnosis gives a window of opportunity to diagnose HIV and offer life- saving HAART.