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• Vol.46 No.9
• CLINICA NEUROL, 46: 668−670, 2006
• Vol.46 No.9 contents

Brief Clinical Note

A case of zoster sine herpete presenting with dysphagia diagnosed by PCR analysis of VZV DNA in auricular skin exudates

Hiroshi Yaguchi, M.D.¹⁾, Mamoru Hisatomi, M.D.¹⁾, Takeshi Sekine, M.D.¹⁾, Kazutaka Matsui, M.D.¹⁾, Mariko Nagatomo, M.D. ²⁾ and Kiyoharu Inoue, M.D.³⁾

¹⁾Department of Neurology, The Jikei University Kashiwa Hospital
²⁾Department of Otorhinolaryngology, The Jikei University Kashiwa Hospital
³⁾Department of Neurology, The Jikei University School of Medicine

A 66-year-old woman was admitted to our hospital because of hoarseness and dysphagia after right earache and pharyngalgia. She showed right glossopharyngeal nerve and vagus nerve palsies, but no other neurological deficits. There was no skin rash within the regions of her ear, oral cavity, pharynx and larynx. Slight increase of mononuclear cells was noted in the cerebrospinal fluid. MR brain imaging was normal. We diagnosed her as zoster sine herpete (ZSH) and treated her with acyclovir, after which she almost completely recovered. The examination of antibodies and DNA of varicella zoster virus (VZV) in the serum and cerebrospinal fluid revealed a pattern of previous zoster infection without evidences of reactivation. However, VZV DNA was detected in auricular skin exudates with PCR. We conclude that PCR analysis of VZV DNA in auricular skin exudates can be a useful diagnostic tool for the diagnosis of zoster sine herpete presenting with painful glossopharyngeal nerve and vagus nerve palsies.

(CLINICA NEUROL, 46: 668−670, 2006)
key words: varicella zoster virus, zoster sine herpete, dysphagia, glossopharyngeal-vagal nerve involvement, PCR

(Received: 27-Jun-06)