SHM Converge Scientific Abstract ePoster Gallery-Pharyngo-Laryngeal Zoster Causing Multiple Cranial and Autonomic Neuropathies: An Atypical Presentation of Varicella-Zoster Virus Infection

Pharyngo-Laryngeal Zoster Causing Multiple Cranial and Autonomic Neuropathies: An Atypical Presentation of Varicella-Zoster Virus Infection

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This case describes an 83-year-old man with hypertension who initially presented with epigastric discomfort, sore throat, hoarseness, painful swallowing, vomiting, and poor appetite, but no skin rash. Laryngoscopy showed left-sided pharyngeal ulcers and partial left vocal cord paralysis, raising suspicion for pharyngo-laryngeal zoster, a rare form of varicella-zoster virus (VZV) reactivation that often lacks cutaneous lesions. Oral valacyclovir was started.<br /><br />Despite antiviral treatment, he later developed syncope and multiple neurologic symptoms. Examination revealed sequential involvement of several cranial nerves and trigeminal neuralgia with an “onion-skin” sensory pattern, suggesting a brainstem-level process. He also had facial nerve palsy and orthostatic hypotension with inadequate compensatory heart-rate increase, indicating autonomic dysfunction. Serology was positive for VZV IgG and IgM.<br /><br />Prednisolone was initiated, after which his trigeminal neuralgia rapidly improved, syncope resolved with improvement in orthostatic hypotension, and facial nerve palsy gradually recovered, resolving completely within about one month.<br /><br />The report emphasizes that pharyngo-laryngeal zoster can present without skin lesions and may be followed by delayed cranial and autonomic neuropathies even after antiviral therapy begins. Serial neurologic examinations during hospitalization are important, and early corticosteroid therapy may help prevent irreversible deficits.

Asset Subtitle

Ritsuki Tanaka

Meta Tag

Author List Ritsuki Tanaka, Ryosuke Horitani, Sho Matsushita, Yusuke Miyazato

Category Clinical Vignettes

Concept Pharyngo-laryngeal zoster

Concept Varicella-Zoster Reactivation

Concept Cranial Neuropathy

Concept Sore Throat

Concept Odynophagia

Distinguished Non-Finalist

Presenter Organization Wakayama Medical University Hospital, Wakayama, Japan

Presenting Author Ritsuki Tanaka

Track Adult

Keywords

pharyngo-laryngeal zoster

varicella-zoster virus

cranial neuropathy

autonomic dysfunction

trigeminal neuralgia

facial nerve palsy

orthostatic hypotension

laryngoscopy

valacyclovir

prednisolone

Pharyngo-laryngeal zoster

Varicella-Zoster Reactivation

Cranial Neuropathy

Sore Throat

Odynophagia