12: Swollen Ear

Medical Mystery Case 12: Swollen Ear

A 24-year-old male, recently diagnosed with HIV seropositivity, presents 24 hours of left ear pain. He saw his doctor the day prior and was told that everything looked okay. Today his pain is worse and noticed that his ear is red and swollen. He also vomited twice and feels �dizzy�. He denies fever and weakness. He denies recent scratching or other trauma. He has no allergies and takes no medication >On exam he is alert, calm and cooperative with an obviously red and swollen left ear >VITAL SIGNS: Temperature 97.9. Blood pressure 132/87. Pulse initially 124, but normal after one liter of normal saline. Respirations 18. Head & neck exam is remarkable for left beating nystagmus> on rightward gaze and subtle weakness of the left face. Cranial nerves are otherwise intact. There is 1+ erythema and swelling of the entire left auricle there are multiple areas of superficial vesicles. Oropharynx is clear. There are> no lesions on the palate. The rest of the physical exam is unremarkable. What is the diagnosis and treatment?

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ANSWER: Ramsay-Hunt Syndrome:

RAMSAY HUNT SYNDROME from �Quick Essentials�
Sx: Pain, vertigo, tinnitus, facial wekness
Signs: Vesicles(can be on tongue and palate), hearing
Rx: IV Acyclovir, ENT

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