A Case of Atypical Ramsay Hunt Syndrome in a Child with Meningitis Who Had a History of Chickenpox Vaccination

We report the case of a 6-year-old boy with atypical Ramsay Hunt syndrome and varicella-zoster virus (VZV) meningitis. The patient had a history of two chickenpox vaccinations. The patient experienced shingles in his left ear, headache and vomiting. VZV was detected by the analysis of cerebrospinal fluid using a polymerase chain reaction (PCR), and a diagnosis of VZV meningitis was made. Acyclovir and prednisolone were administered, and no sequelae occurred. Since October 2014, a periodic chickenpox vaccination program has been implemented in Japan, and this program is expected to decrease the incidence of chickenpox. Additionally, the prevention of herpes zoster or Ramsay Hunt syndrome, the etiology of which involves the reactivation of latent VZV in ganglion cells, is expected. Although no direct history of chickenpox has been observed after the implementation of the vaccination program, facial paralysis with herpes zoster oticus, as in this case, has been observed. Consequently, Ramsay Hunt syndrome should not be excluded from a differential diagnosis in patients with facial palsy even if they have a history of chickenpox vaccination. In patients with Ramsay Hunt syndrome and a history of vaccination, determining the causative virus, i.e., whether it is a wild strain or a vaccine strain, is important in discussion of etiology.