Pathology · patient case question
Which virus is involved?
Patient case: Case: facial palsy with an ipsilateral rash
Scenario: The case describes unilateral facial paralysis accompanied by a vesicular rash on the same side.
Show answer and explanation
Correct answer: C. Varicella zoster virus (HHV-3)
- A. CMV causes disease mainly in the immunocompromised and in congenital infection; it does not produce this picture.
- B. HSV-1 is implicated in idiopathic Bell palsy, but Bell palsy has no rash. The rash is what makes this zoster.
- C. Correct. Facial palsy with a vesicular rash in the ear or on the same side of the face is Ramsay Hunt syndrome — reactivation of varicella zoster in the geniculate ganglion.
- D. EBV causes infectious mononucleosis, hairy leukoplakia and nasopharyngeal carcinoma — not a dermatomal vesicular rash with palsy.
Note: Ramsay Hunt carries a worse prognosis for recovery than Bell palsy, so prompt antiviral plus corticosteroid therapy matters.