Herpes Zoster Otikus Dengan Paresis Nervus Fasialis (Sindrom Ramsay Hunt) Pada Pasien Imunokompromais
DOI:
https://doi.org/10.36408/mhjcm.v7i1.437Keywords:
Sindrom Ramsay Hunt, Herpes Zoster Otikus, Paresis Nervus Fasialis, ImmunokopromaisAbstract
Latar belakang: Sindrom Ramsay Hunt (SRH) merupakan komplikasi yang jarang terjadi pada herpes zoster. SRH dapat terjadi tanpa adanya ruam kulit (zoster sine herpete). Karena gejala-gejala ini tidak selalu muncul saat onset, sindrom ini sering salah didiagnosis. Insidensi 5/100.000 kasus pada populasi di Amerika Serikat dan meningkat pada kelompok umur di atas 60 tahun dan kondisi imunokompromais.
Laporan Kasus: Laki-laki, 66 tahun, timbul plenting-plenting di daerah telinga kiri menyebar ke dada sebelah kiri sejak 8 hari sebelum dikonsulkan. Terdapat nyeri pada telinga, pendengaran berkurang, pusing berputar, wajah sebelah kiri sulit digerakkan dan sulit berbicara. Permeriksaan fisik ditemukan vesikel berkelompok dengan dasar kulit eritem dan edema, bula, erosi, krusta, konfigurasi herpetiformis, distribusi unilateral, segmental setinggi persarafan servikal 2-4. Temuan tzank test menunjukkan sel datia berinti banyak. Penatalaksanaan dengan sistemik asiklovir dan metilprednison.
Pembahasan: SRH merupakan hasil reaktivasi virus varicella zoster laten diganglion genikulatum yang menyebabkan vesikel pada aurikula, otalgia dan paresis/paralisis fasialis. Mekanisme pencetus reaktivasi pada pasien ini diduga berhubungan dengan imunokompromais (keganasan). Pasien imunokompromais memiliki resiko 20-100 kali lebih besar. Pemeriksaan Tzank sesuai dengan gambaran herpes zoster. Terapi SRH yang paling disarankan adalah terapi kombinasi antivirus dan kortikosteroid.
Kesimpulan: Telah dilaporkan kasus herpes zoster otikus dengan paresis nervus fasialis (Sindrom Ramsay Hunt) pada pasien imunokompromais. Hasil terapi memuaskan. Prognosis qua ad vitam ad bonam, ad sanam dubia ad malam, ad cosmeticam dubia ad bonam.
Kata kunci: Sindrom Ramsay Hunt, Herpes Zoster Otikus, Paresis Nervus Fasialis, Immunokopromais.
Background; Ramsay Hunt Syndrome (RHS) is a rare complication in shingles. RHS can occur without the presence of skin rash (zoster sine herpete). Because these symptoms do not always appear at onset, RHS is often misdiagnosed. The incidence of 5/100,000 cases in the US and increase in the age above 60 years and immunocompromised.
Case: A 66-years-old male complaint of vesicle on the left ear spreading to left chest, since 8 days prior to the consultation. There was otalgia, dizziness, hearing impairment, difficulty in movement and speaking on the left side. Physical examination found clustered vesicle on an erythematosus and oedematous base, bullaes, erosions, crusts, in a herpetiformis configuration, unilateral distribution, in a level of 2-4 cervical nerve innervation. The Tzank test showed multinucleated giant cells. Management with systemic acyclovir and methylprednisolone.
Discussion: RHS is the result of reactivation of latent varicella zoster virus in geniculate ganglion which causes vesicles in the auricle, otalgia and facial paresis / paralysis. The mechanism for triggering reactivation in these patients is immunocompromise (malignancy). Immunocompromised have a 20-100 times greater risk. Tzank results in accordance with diagnostic of herpes zoster. The most recommended therapy is combination of antiviral and corticosteroid.
Conclusion: The case of herpes zoster oticus with facial nerve paresis (Ramsay Hunt Syndrome) in immunocompromised has been published. The result of therapy was satisfying. The prognosis qua ad vitam ad bonam, ad sanam dubia ad malam, ad cosmetics dubia ad bonam.
Keywords: Ramsay Hunt Syndrome, Herpes Zoster Oticus, Facial Nerve Paresis, Immunokopromised.
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