Background: 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 agrade 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.
Conclusion: 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.