Atypical presentation of Ramsay Hunt syndrome without facial palsy in an immunocompetent young male

We report the case of a 28 year old man complaining otalgia, mild odynophagia, small vesicles on the neck and the swelling of regional lymph nodes. A dermatologist promptly diagnoses Herpes Zoster and prescribes acyclovir-steroid (prednisone) therapy (AS), that the patient buys and takes immediately. He does not complain fever, hearing loss, nausea, vomiting or vertigo. There was no reduction of taste sensation, no ataxia or nystagmus, Romberg sign was negative. Muscle strength was normal. The strict definition of Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by erythematous vesicular rash on the ear or in the mouth. Our patient targets two of the three criteria needed for the diagnosis of Ramsay Hunt syndrome. We explain that because he was immunocompetent, he was young and begun to take AS therapy very early. This suggests that prompt diagnosis and management improves outcome in Ramsay Hunt syndrome.