Facial Paralysıs During Varicella Zoster Infectıon in a child

Introduction: Primary infection with varicella-zoster virus (VZV) results in chickenpox, characterized by viremia with a diffuse rash and seeding of multiple sensory ganglia, where the virus establishes lifelong latency. Herpes zoster is caused by reactivation of latent VZV in cranial-nerve or dorsal-root ganglia, with spread of the virus along the sensory nerve to the dermatome. Both entities have a benign clinical course in immunocompetent and young individuals. Although Herpes zoster virüs may result in Ramsey Hunt sendrom, it may rarely cause peripheral facial paralysis in the course of varicella.Case report: A 4-year-old girl patient was admitted to the ear, nose, and throat clinic with a complaint of a rash over the body with vesicles and pustules a few days. She had left peripheral facial palsy about 2 days ago. In a general clinical examination, a few macular lesions, probably residues of vesicles, and fluid-filled blisters and pustules were observed on the back, chest, abdomen, upper, and lower limbs. She had remarkable left peripheral facial palsy. Her facial palsy was assessed as a grade II using the House-Brackmann Score. Otoscopic examination was normal and otalgia and auricular vesicle was absent. 1 mg/kg/day prednisone and 30 mg/kg/day acyclovir therapy were given to the patient due to the peripheral facial nerve palsy involvement of the VZV infection. Complete remission was achieved at 1 month after treatment.Conclusion: Varicella-zoster virus (VZV) is one of eight herpes viruses known to cause human infection and is distributed worldwide. While the results of bell palsy are good, facial paralysis results during viral infections are severe. Cranial nerve involvement secondary to viral infection should be followed closely. The current standard of care for treatment is acyclovir and prednisone. Thus early treatment can be started in the face of developing complications and possible mortality and morbidity can be prevented.

引言：水痘-带状疱疹病毒（varicella-zoster virus, VZV）的原发感染会引发水痘，其特征为病毒血症伴弥漫性皮疹，并播散至多个感觉神经节，病毒可在此处建立终身潜伏感染。带状疱疹则是由潜伏于脑神经或脊神经节内的VZV再激活所引起，病毒会沿感觉神经播散至相应皮节。上述两种疾病在免疫功能正常的年轻个体中均呈现良性临床病程。尽管带状疱疹可引发拉姆齐·亨特综合征（Ramsey Hunt Syndrome），但在水痘病程中极少出现周围性面瘫。

病例报告：一名4岁女童因数日来全身出现伴水疱与脓疱的皮疹就诊于耳鼻咽喉科门诊，约2天前出现左侧周围性面瘫。体格检查可见背部、胸部、腹部及上下肢存在少量斑疹（可能为水疱愈合后残留），以及充满液体的水疱与脓疱。该患儿左侧周围性面瘫症状显著，采用House-Brackmann评分系统（House-Brackmann Score）评估为Ⅱ级。耳镜检查未见异常，无耳痛及耳部水疱。鉴于该患儿的周围性面瘫由VZV感染累及面神经所致，予其1mg/kg/天的泼尼松联合30mg/kg/天的阿昔洛韦治疗。治疗1个月后患儿完全缓解。

结论：水痘-带状疱疹病毒（VZV）是已知可引发人类感染的8种疱疹病毒之一，在全球范围内均有分布。尽管贝尔麻痹（Bell palsy）的预后良好，但病毒感染相关的面瘫病情往往较重。对于病毒感染继发的脑神经受累情况，应予以密切随访。目前的标准治疗方案为阿昔洛韦联合泼尼松。因此，在出现并发症征兆时可及时启动治疗，从而预防可能出现的死亡与残疾。