PMC5067093_01
Varicella rash first seen in (a) left ear, followed by disseminated rash on (b) face, (c) legs, (d) chest, and (e) back.
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Over the next 24 h, he developed erythematous papules with vesicles on his left ear (Fig. 1(a)) and along his left face, scalp, neck, chest, abdomen, back, and leg (Fig. 1(b)-(e)).
Cranial nerve deficits associated with Ramsay Hunt syndrome. Patient (a) trying to smile and raise eyebrows suffers from paralysis on left side, (b) trying to close both eyes but unable to fully close left eye, and (c) unable to abduct left eye past midline when looking to left.
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He had weakness of both upper and lower facial muscles suggesting lower motor facial nerve palsy (Fig. 2(a)-(b)). He also developed new diplopia secondary to a new left abducens nerve palsy with lateral rectus dysfunction (Fig. 2(c)).