| BackgroundHerpes zoster(HZ)is a kind of common acute infectious disease in dermatology caused by the varicella-zoster virus(VZV).Herpes zoster is characterized by a unilateral band arrangement of vesicles on an erythematous base,often with neuralgia.The initial infection with VZV may present as Varicella or latent infection,VZV remains latent in the dorsal root ganglion cells for a long time.The virus is then reactivated by certain promotive factors and travels down the nerve fibers to the skin,causing nerve inflammation and necrosis,pain,and erythema or blisters.The diagnosis of HZ is easily made clinically,and antiviral therapy is the cornerstone in the management of herpes zoster.Ramsay-Hunt syndrome(RHS),also known as herpes zoster geniculate ganglion syndrome,is one of the rare clinical manifestations of herpes zoster.The disease is caused by the reactivation of latent VZV in the facial nerve and the involvement of the sensory geniculate ganglion,resulting in both sensory and motor dysfunction of the facial nerve.The typical clinical presentation is a triad of facial palsy,otalgia,and herpes of the external auditory canal.In addition,due to complex branches of the facial nerve,other symptoms are often present,such as hypoesthesia of the anterior 2/3 of the tongue due·to the involvement of the bulbar nerve and auditory hypersensitivity due to the involvement of the stapedial nerve.RHS is uncommon,with complex and variable clinical manifestations,and clinicians are unaware of it.If patients with RHS are not diagnosed and treated in time,serious sequelae are often left behind,which seriously affect the quality of life of patients.Especially when there are only prodromal symptoms without rash,patients often consult other departments and are prone to underdiagnosis and misdiagnosis,and there are few studies on Ramsay-Hunt syndrome.ObjectivesWe analyzed and summarized the clinical and prognosis-related data of RHS patients,and discussed the clinical characteristics of RHS to improve the understanding of the disease,reduce the occurrence of missed diagnosis and misdiagnosis,and provide references for the future clinical treatment of RHS.MethodsWe collected detailed clinical data of patients with RHS attending the First Affiliated Hospital of Zhengzhou University from December 2011 to December 2021,and patients were followed up by telephone a month after discharge,of which a total of 34 cases had complete data.The gender composition,age distribution,concomitant diseases,season of onset,precipitating factors,first presentation,first department,early misdiagnosis,site of rash,order of appearance of the RHS triad,time from onset to diagnosis,treatment an,d prognosis of the RHS patients were retrospectively analyzed and statistically processed.The statistical software was SPSS 26.0,and Fisher’s exact test was used for unordered categorical variables,and the differences were statistically significant when P<0.05.Results1.Gender:There were 20 males and 14 females,and the ratio of male to female was approximately 1.43.2.Age:The onset age was from 14 years to 74 years,with a median age of 54 years.3.Complicated with other diseases:4 cases with previous physical health,30 cases with other combined diseases,mainly combined with multiple diseases.4.Season of onset:11 cases in spring,11 cases in autumn,8 cases in winter,and 4 cases in summer.The onset of RHS was mainly in spring and autumn.5.Predisposing factor:18 cases had no obvious causes before onset,8 cases had a history of exertion,3 cases had irregular life,2 cases had a history of upper respiratory tract infection,2 cases were during menstruation,and 1 case had a history of recent surgery.6.First manifestations:Pain was the first presentation in 16 cases,vestibular symptoms in 8 cases,herpes in 4 cases,facial nerve palsy in 3 cases,and tinnitus or hearing loss in 3 cases.7.Primary diagnosis department and early misdiagnosis:14 cases were diagnosed in dermatology and 20 cases in other departments.The first diagnosis of RHS was 14 cases,and there were 20 cases of missed or misdiagnosis.There was no statistically significant difference between whether the first department was dermatology and the early misdiagnosis.8.Sites of skin lesions:The rash was located on the right side in 18 cases and on the left side in 16 cases,and the radio from right to left was about 1.13:1.24 cases developed the rash on a single site,including 11 cases in the external auditory canal,9 cases in the auricle,and 4 cases in the periauricular region;10 patients developed the rash on two or more sites simultaneously.9.The order of appearance of the RHS triad:"Pain→rash→facial palsy" in 17 cases;"pain→facial palsy→rash" in 4 cases;"rash→pain→facial palsy" in 9 cases."Facial palsy→pain→rash" in 3 cases;"facial palsy→rash→pain" in 1 case.No patient with the sequence of "rash facial palsy→pain" was found.10.Time between onset to diagnosis:The onset time was from the first day to 18 days,with a median time of 3 days.11.Treatment:All patients received antiviral combined with glucocorticoid therapy,but the timing of receipt varied.A combination of antibiotics,analgesics,neurotrophic drugs,physiotherapy,and Chinese herbal therapy was also applied individually.12.Prognosis:21 cases were cured,5 cases were left with pain,5 cases were left with facial paralysis and pain,and 3 cases were left with facial paralysis.The prognosis was statistically significant with respect to the timing of patients receiving antiviral combined with glucocorticoid treatment.Conclusions1.Ramsay-Hunt syndrome is rare in clinical practice,the early manifestations lack specificity,and it is easy to miss the diagnosis and misdiagnosis.Clinicians should improve their understanding of this disease.2.There are many treatment modalities for Ramsay-Hunt syndrome,but early effective antiviral therapy and the use of glucocorticoids are important factors to improve the prognosis. |
