Multidermatomal herpes zoster involving CN V3 and C2 territories with simultaneous vestibulocochlear deficit: A case report

Herpes zoster is characterized by the presence of unilateral, localized vesicular rash in a dermatomal distribution. Although in most cases herpes zoster affects a single dermatome, multidermatomal involvement may occur in rare cases. PATIENT CONCERNS: In this case report, we describe an immunocompetent patient with multidermatomal herpes zoster involving the cranial nerve (CN) V3 and C2 territories with simultaneous vestibulocochlear deficits. We demonstrate the results of temporal bone magnetic resonance imaging and discuss the pathophysiological mechanism of the patient’s characteristic clinical manifestation. DIAGNOSES: The diagnosis of multidermatomal herpes zoster involving CN V3 and C2 territories with simultaneous vestibulocochlear deficit was made. Vestibular function test and pure tone audiometry revealed ipsilateral vestibular impairment and hearing loss. INTERVENTIONS: The patient was admitted for treatment with systemic steroids and antiviral agents. OUTCOMES: After treatment, vertigo and hearing loss improved, and the skin lesions healed well without scarrings. LESSONS: Considering that the afferent sensory fibers of the CN V and C2 converge in the trigeminocervical nucleus, herpes zoster involving contiguous dermatomes of CN V3 and C2 in the patient may be explained by neural-to-neural spread. And considering that temporal bone magnetic resonance imaging revealed enhancement of the dura of the internal auditory canal without enhancement of CN VII or VIII, the vestibulocochlear deficits in the patient may be caused by inflammation of the inner ear transmitted via the cerebrospinal fluid.