A 63-year-old male with psoriasis on cyclosporine develops a crusting vesicular rash on the RIGHT FACE that does NOT cross the midline, limited mobility of facial muscles, and TINNITUS on the right side. Which syndrome is MOST likely?

Correct answer: C. Ramsay Hunt syndrome

• A. Incorrect. Melkersson-Rosenthal syndrome causes recurrent facial swelling, fissured tongue, and facial palsy — but WITHOUT vesicular rash or tinnitus.
• B. Incorrect. Trigeminal neuralgia causes paroxysmal electric-shock facial pain — no vesicular rash or facial palsy.
• C. Correct. The clinical picture — UNILATERAL vesicular rash NOT crossing the midline + FACIAL MUSCLE WEAKNESS + TINNITUS — is the classic TRIAD of RAMSAY HUNT SYNDROME (herpes zoster oticus). VZV reactivates in the GENICULATE GANGLION of CN VII → vesicular rash in the ear/face + facial palsy + CN VIII involvement (tinnitus/vertigo/hearing loss). Cyclosporine (immunosuppressant for psoriasis) predisposed this patient to VZV reactivation.
• D. Incorrect. Guillain-Barré is an ascending peripheral neuropathy — symmetric weakness, not unilateral vesicular rash with tinnitus.