A Case of Ramsay Hunt Syndrome in Living-Kidney Transplant Recipient

• Published in: Transplantation proceedings 2012, Vol.44 (1), p.307-308
• Main Authors: Otsuki, K, Kenmochi, T, Maruyama, M, Akutsu, N, Iwashita, C, Ito, T, Matsumoto, I, Asano, T
• Format: Article
• Language: English
• Subjects: ABO Blood-Group System - immunology; Adult; Antiviral Agents - therapeutic use; Biological and medical sciences; Blood Group Incompatibility - immunology; Desensitization, Immunologic - methods; DNA, Viral - isolation & purification; Drug Therapy, Combination; Early Diagnosis; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Herpes Zoster Oticus - diagnosis; Herpes Zoster Oticus - drug therapy; Herpes Zoster Oticus - virology; Herpesvirus 3, Human - genetics; Herpesvirus 3, Human - isolation & purification; Histocompatibility; Humans; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - adverse effects; Kidney Transplantation - immunology; Living Donors; Magnetic Resonance Imaging; Medical sciences; Plasma Exchange; Plasmapheresis; Predictive Value of Tests; Real-Time Polymerase Chain Reaction; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2011.12.011

Abstract A 36-year-old woman underwent ABO-incompatible living-donor kidney transplantation. Immunosuppression was achieved by quadruple therapy with tacrolimus, basiliximab, mycophenolate mofetil (MMF), and prednisone. Desensitization and removal of anti-ABO antibody was achieved by administration of MMF for 4 weeks before transplantation followed by intravenous administration of rituximab, double-filtered plasmapheresis, and plasma exchange. At 1 month after transplantation, she complained of left ear pain without vesicle rash, tinnitus, and vertigo. Physical examination revealed left facial paralysis and nystagmus. T2 fluid-attenuated inversion recovery magnetic resonance imaging (MRI) visualized swelling of the left facial nerve. Real-time polymerase chain reaction showed the existence of varicella zoster virus DNA in the patient's tears and saliva. The final diagnosis was Ramsay Hunt syndrome without vesicle rash, which is called zoster sine herpete. The patient was treated by intravenous administration of acyclovir (3 mg/kg, 3 times per day) in addition to the reduction of the MMF dose. For facial nerve palsy, prednisolone was prescribed for 3 days and then gradually tapered. These treatments improved the symptoms of tinnitus and vertigo after a month; the facial nerve palsy completely disappeared after 10 months. This case demonstrated MRI to be a useful modality for the early diagnosis of Ramsay Hunt syndrome without vesicle eruption.