Age: 6.0
Sex: F
Vaccine: VARCEL
Symptoms: Nystagmus, Oedema, Otitis externa, Polymerase chain reaction, Tinnitus
Clinical narrative: The following is the abstract of a published article. "We herein present a case of 6-year-old female demonstrating atypical Ramsay-Hunt syndrome. She presented with an earache, severe vertigo, and vomiting at onset, and thereafter, herpes zoster oticus appeared. No facial nerve palsy was seen. She was vaccinated with a dose of varicella virus vaccine live (manufacturer unknown) for varicella and had no past history of apparent varicella infection. The patient showed positive immunoglobulin G (IgG) and negative immunoglobulin M (IgM) serum antibodies for varicella-zoster virus (VZV). An analysis of VZV-DNA from the patient's ear lesion using allergic discrimination real-time PCR identified a wild-type strain of VZV. We diagnosed her to have atypical Ramsay-Hunt syndrome caused by reaction of the VZV. Aciclovir and prednisolone were administered, and she recovered completely. This case indicates that Ramsay-Hunt syndrome could be caused by a VZV infection after vaccination, event though its frequency is low. Ramsay-Hunt syndrome may thus be considered as one of causes of sudden onset vertigo in children". Follow up information was received from a literature article concerning a 6-year-old girl developed atypical Ramsay-Hunt syndrome due to reactivation of varicella zoster virus following varicella zoster virus vaccination (manufacturer unknown). The girl, who had received the varicella zoster virus vaccines (manufacturer unknown) (dose, lot # and route not reported) at 1 year of age, developed mild deafness in the left ear and an earache. She was prescribed an analgesic for external otitis. Her deafness gradually improved, but from day 5 of symptom onset, she experienced vertigo and vomiting. She developed abdominal pain on day 6, and received fluid transfusions and antiemetic therapy. She was admitted to hospital on day 9 following the onset of a headache: On admission, she had mixed horizontal and torsional nystagmus in the right-hand direction and left tinnitus. Vesicles were noted in the left auricular area, with reddening in the left tympanum. The eighth cranial nerve was impaired and she had persistent vertigo when opening her eyes or attempting to raise her head. Serum was positive for varicella zoster virus IgG antibody and varicella zoster virus was detected in left auricle vesicle fluid. Atypical Ramsay Hunt syndrome was diagnosed. Aciclovir was initiated on the day of admission. The girl's dizziness improved, and prednisolone was started to reduce oedema and inflammation in the eighth cranial nerve. She regained her ability to sit up, and her dizziness and nystagmus resolved. Prednisolone was progressively reduced and discontinued. She was able to walk and experienced no worsening of abdominal pain. She was discharged on day 10. Analysis of vesicle fluid confirmed that the varicella zoster virus was a circulating field strain. There are two possible mechanisms for onset: the patient suffered the initial infection of the varicella zoster virus field strain or there was reactivation of the dormant varicella zoster virus infection as a result of the vaccine. The author believes that the latter mechanism is more likely. Additional information is not expected.