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Article in Japanese

A case of Ramsay-Hunt syndrome caused by reactivation of sub-clinical varicella zoster virus infection after vaccination

Yoichi TAKEMASA1,2), Yoshiki KUSAMA1,2), Nobuhiko OKABE2,3)

This study reports a case of 13-year-old boy with Ramsay-Hunt syndrome (RHS). He had received a one-time varicella vaccination and no previous history of varicella (chicken pox). The patient presented with vertigo and hearing impairment as symptoms of herpes zoster oticus. Since he did not present facial palsy, his illness was diagnosed as atypical RHS. An analysis of varicella zoster virus (VZV)-DNA via allelic discrimination real-time polymerase chain reaction (PCR) identified the virus as a wild type VZV. Therefore, vaccine failure that triggered a previous sub-clinical varicella infection was suspected, causing reactivation of the virus. This resulted in atypical RHS, despite the patient receiving one dose of VZV vaccine. RHS can leave facial palsy as a permanent sequela, but fortunately, the patient recovered without this outcome after being administered acyclovir and prednisolone. A routine varicella vaccination program started in Japan in October 2014, which is expected to decrease the morbidity and mortality caused by varicella infection. However, it is not apparent whether the varicella vaccination would also prevent herpes zoster. Therefore, a surveillance of both varicella and herpes zoster is essential.

1) Department of Pediatrics, Fuji City General Hospital
2) Department of Pediatrics, The Jikei University Hospital
3) Kawasaki City Institute for Public Health

Key words
Received June 20, 2016
Accepted January 23, 2017

29 (1):24─28,2017