特異な臨床症状（特に全身発疹）を呈したハント症候群症例

RAMSAY HUNT SYNDROME WITH UNUSUAL CLINICAL FINDINGS ERUPTIONS SPREADING OVER THE ENTIRE BODY

　I．緒言

　顔面神経麻痺は日常診療に際し，かなり頻繁に遭遇する疾患であるが，そのうち外耳道周辺部疱疹，内耳障害を伴うHunt症候群は，比較的稀なものである。

　著者は最近，耳介，外耳道のみでなく全身に水痘様発疹を生じるという特異な臨床像を呈したHunt症候群の症例を経験した。この症例は，完全な顔面神経麻痺，高度な聴力および平衡障害を伴い，その経過中に左右注視方向性眼振が観察され，さらに外耳道後壁に腐骨を生じ，結局，顔面神経麻痺に対しては減荷手術を行なわざるを得なかつた。

　A 46 year-old male complained of vertigo, right facial palsy, right earache and vesicles on the right concha. From clinical examinations this case was diagnosed as Ramsay Hunt syndrome. A group of remarkable symptoms occurred in this case in that the zosteriform eruptions were seen not only involving the concha but spreading over the entire body, bony sequestration was formed in the posterior wall of the right external meatus and gaze nystagmus occurred transiently in bilateral directions.

　After the failure of conservative treatment on facial palsy for the period of 3 months, decompression operation had finally brought the cure. The following conclusions were drawn from this experience :

　1) The rash that gave resemblence of a chickenpox was considered to have developed from herpes zoster oticus which covered the entire body. The formation of sequestrum as well as the presence of deafness and vestibular disturbance pointed to the seriousness of the inflammation.

　2) Generally, the presence of gaze nystagmus in bilateral directions arouses suspicion of brain stem affection. But in this case, the gaze nystagmus was considered to be caused by peripheral vestibular disturbance.

　3) Although decompression of the facial nerve in Ramsay Hunt syndrome was successful in this case, but, from clinicopathological point of view, it cannot be said to be effective always.