Three cases of laryngeal herpes zoster

Herpes zoster is caused by endogenous reactivation of latent varicella-zoster virus. Herpes zoster is characterized by a vesicular rash and mucositis, and paralysis of various nerves. Cases of Ramsay Hunt syndrome are frequently encountered by otolaryngologists, as are cases of herpes zoster involving the glossopharyngeal nerve region and vagus nerve supply region. Herein, we report three cases of herpes zoster involving the pharyngolaryngeal region. In the first case, the patient presented with vesicular eruptions in the larynx and paralysis of the glossopharyngeal, vagus, and accessory nerves on the left side. After treatment, the paralyses of the glossopharyngeal and accessory nerves were resolved, whereas paralysis of the vagus nerve persisted. In the second case, the patient presented with vesicular eruptions on the left side of the larynx, associated with paralysis of the acoustic, glossopharyngeal, and vagus nerves on the left side. The acoustic and vagus nerve persisted even after therapy. These two cases were diagnosed as having varicella-zoster virus (VZV) infection based on elevated VZV IgG and IgM levels. In the third case, the patient presented with paralysis of the acoustic, glossopharyngeal, and vagus nerves on the left side, but there were no vesicular eruptions. CSF examination revealed a high concentration of VZV-DNA in the cerebrospinal fluid. In this case also, the paralysis of the acoustic and vagus nerves persisted after the treatment. In cases of latent varicella zoster virus infection presenting with rashes in the pharyngolaryngeal region as the initial symptom, paralysis of the facial and acoustic nerves are frequently seen, followed by paralysis of the glossopharyngeal and vagus nerves. Further, half of the cases reported in the literature did not present with any vesicular eruptions, and delay in treatment worsened the neurological prognosis. Therefore, this disease should be considered in the differential diagnosis so that therapeutic intervention can be provided at an early stage.