BMJ Case Reports 2012; doi:10.1136/bcr.01.2012.5538
  • Unusual presentation of more common disease/injury

Where is reactivation after a long latency?

  1. Akane Yamabe
  1. General Internal Medicine, Ohta-Nishinouchi Hospital, Koriyama City, Japan
  1. Correspondence to Dr Chisho Hoshino, chisho{at}


The authors present a 90-year-old woman with unilateral glossopharyngeal, vagal and spinal accessory cranial nerve palsy along with pharyngeal and laryngeal vesicular eruptions. She was diagnosed with herpes zoster based on PCR testing on vesicular fluid for varicella-zoster virus (VZV). Reactivation of VZV in the head and neck region can cause life-threatening neurologic sequelae. Clinicians should be alert to the possibility of herpes zoster in a case of unilateral multiple cranial neuropathies and rapid combination therapy with acyclovir and corticosteroid should be initiated.


  • Competing interests None.

  • Patient consent Obtained.

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