Ramsay Hunt syndrome in a patient with H7N9 influenza virus infection.

To the Editor: We would like to present Ramsay Hunt syndrome (RHS) as a complication of H7N9 influenza virus infection. On January 22, 2014, a 57‐year‐old man with a history of rheumatoid arthritis was admitted to the hospital complaining of dyspnea and fever. Infection with influenza A (H7N9) virus was confirmed from a tracheal aspirate sample using polymerase chain reaction (PCR) assays. Hypoxemia led to non‐invasive mechanical ventilation on the first day. Methylprednisolone (80 mg intravenous every 24 hours) and oseltamivir were administered starting from the first day. On day 11, otalgia and secretion of yellow exudate was associated with a swollen right external auditory canal. Four days later, a vesicular rash developed at the right earcanal and pinna. Symptoms progressed over the following 48 hours in which right facial palsy, dysphagia, hoarseness, hearing loss, and vertigo were all present in the patient [Figure 1]. Deviation of the uvula to the left and paralysis of the right soft palate was consistent with pharyngeal hyporeflexia and the constellation of symptoms confirmed the diagnosis of RHS. Penciclovir cream, methylprednisolone (40 mg intravenous daily for two days, followed by a gradual taper of oral glucocorticoids), acyclovir (2105 mg intravenous for one day), foscarnet sodium (3 g daily for 11 days), and methycobal injection (1 mg daily for one week) were all administrated. Thirteen days later, the otalgia, vesicular rash, and swollen external auditory canal had resolved. The patient was successfully weaned from machenical ventilation on day 33. The facial paralysis, hoarseness, and vertigo were gradually ameliorated and were completely recovered on day 52 [Figure 2]. Right facial nerve and vestibulocochlear nerve were still showed enhancement by cerebellopontine angle (C‐P angle) district magnetic resonance imaging (MRI) on day 57. The sensorineural and conductive Ramsay Hunt Syndrome in a Patient with H7N9 Influenza Virus Infection