Varicella Zoster Cranial Polyneuropathy Presenting With Dysphagia, Esophagitis and Gastroparesis

CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Figure 1. Upper gastrointestinal endos-copy showing, (A) ulceration in laryngo-pharynx and (B) circumferential ulcers in the esophagus. We present an immunocompetent patient with herpes zoster, multiple cranial nerves paralysis and persistent dysphagia, which is rarely reported. A 50-year male presented with absolute dysphagia, odyno-phagia, nasal regurgitation, hoarseness of voice and painful eruptions on left ear for 10 days and fever and cough for 5 days. Examination revealed vesicular rash on left ear and oropharynx, crepitations in the chest, left infra-nuclear facial, glossophar-yngeal and vagus nerve palsy. Investigations: hemoglobin 13 g/dL, total lymphocyte count 2.9 × 10 6 /mm 3 (85% neutrophils). Liver and kidney function tests and glucose were normal. Chest X-ray revealed pneumonia, blood, sputum culture and HIV serology were negative. Upper endoscopy revealed right-ward deviation of uvula, left vocal cord palsy, whitish vesicular lesions over oropharynx and vocal cords and circumferential ulceration of esophagus (Fig. 1). Esophageal tissue revealed intra-nuclear inclusion bodies on Tzanck smear (Fig. 2), acute inflammatory exudates on biopsy and negative