A 55 year-old-male presented to the dermatology clinic with diffused erythema and clustered vesicles affecting the left chest and right ear (Fig. 1a, b). He complained severe pain in the affected region. One week before, some vesicles appeared after taking alcohol. The typically neuropathic pain, such as burning sensation, Shock-like pain, stabbing pain, and feeling of numbness, has been accompanied by the rash. He took some anodyne in an attempt to relieve the pain, but it does not affect reducing symptoms. In the following days, there was a facial asymmetry that occurred in this patient, and the patient developed exudating in his right ear canal.
In the physical examination, grouped blisters, even hernorrhagicbulls with an erythematous base, appeared on his left chest and back along T4-T6 dermatomes. Some blisters had been ruptured and scabbed. The patient’s face was asymmetrical with the droopy corner of the right mouth, and his right nasolabial fold became flattened, and the right eyelid could not be completely closed. The tympanic membrane was integral, but yellow to white exudation was observed on the surface of the external auditory canal.
Laboratory investigations, pure tone audiometry tests, and ear examination were routine. He did not have any chronic disease, medical history, recent weight loss, or exposure to any infectious diseases. The patient was not performed virology tests because the disease could be diagnosed based on typical clinical manifestations. He received the treatment of penciclovir 250 mg twice by dripping and methylprednisolone 40 mg once daily. Pain relief with oral gabapentin and super laser irradiation. By using this therapy for 1 week, vesicles over the right ear and left chest had been absorbed and crusted. The patient could perceive the pain relieving effect. Besides, the right facial palsy with lagophthalmus had slightly improved during this period. Continuation of hospitalization has been advised to the patient, but he denied and left the hospital voluntarily. After being discharged, he took oral valaciclovir 500 mg twice daily, methylprednisolone 24 mg per day, and mecobalamin for 7 days. Besides, acupuncture therapy was conducted on the patient once a week in a traditional Chinese medicine hospital. Two weeks after being discharged, the patient could almost close his right eyelid, and his feeling of pain was entirely resolved. And then, the dose of methylprednisolone had been reduced gradually and discontinued within 1 month. After 2 months follow-up, this patient could close his right eyelid completely, flattened nasolabial fold, and droopy corner of the mouth on his right side has also been improved. (Fig. 2).