A case report of Ramsay Hunt Syndrome involving the cervical dermatomes in Nigeria

A rare neurological disorder, Ramsay Hunt Syndrome is caused by reactivation of varicella-zoster virus in the geniculate ganglion. The syndrome typically comprises a triad of unilateral facial palsy, vesicular rash around the ear canal or mouth and otalgia. However, atypical cases occur posing diagnostic challenges and risk of poorer outcomes. The purpose of this report is to highlight an atypical presentation of this syndrome where published cases are limited. We describe a 56-year-old Nigerian woman who presented with incomplete triad of Ramsay Hunt Syndrome characterized by unusual cervical dermatomal distribution of the zoster rash, facial palsy and absence of otalgia. Despite initial missed diagnosis elsewhere, timely administration of Acyclovir and Prednisolone resulted in marked clinical improvement. The atypical presentation highlights the importance of considering Ramsay Hunt Syndrome in patients with facial palsy and a rash anywhere in the head and neck even if the classic triad is incomplete.