title: Atypical Presentation of a Common Disease: Shingles of the Larynx.
abstract: OBJECTIVE
  Herpes zoster is a neurocutaneous disease resulting from the reactivation of endogenous varicella-zoster virus (VZV) in dorsal sensory or cranial nerve ganglia. Rarely, this infection manifests without the characteristic dermatomal rash, a condition termed zoster sine herpete. Viral spreading of herpes zoster in the head and neck may manifest as various signs and symptoms because of the multiple possible combinations of cranial neuropathies. With only six cases reported in the English literature up to now, isolated neuropathies of the vagus nerve in the absence of cutaneous lesions tend to be misdiagnosed as idiopathic laryngeal paralysis.
  
  
  METHODS
  We report a case of herpes zoster of the larynx in an 80-year-old man presenting with sore throat, dysphagia, and hoarseness.
  
  
  RESULTS
  Endoscopic examination revealed unilateral vocal fold paralysis, pooling of secretions, and mucosal vesicles of the hemilarynx. After the diagnosis of VZV infection with polymerase chain reaction (PCR) testing, the patient was treated with valacyclovir and corticosteroids, leading to complete recovery after 2 months.
  
  
  CONCLUSIONS
  Herpes zoster of the larynx is an uncommon condition that should be included in the differential diagnosis of laryngeal paralysis of idiopathic cause. We recommend performing a thorough examination of the pharyngolaryngeal structures and ordering PCR testing as the diagnostic method of choice.
authors: Faculty of Medicine, McGill University, Montreal, Quebec, Canada. Electronic address: sarah.f.hosseini@gmail.com.
authors: Sarah
authors: S
authors: Hosseini
authors: Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada; Department of Otolaryngology, King Abdulaziz University, Jeddah, Saudi Arabia.
authors: Faisal
authors: F
authors: Zawawi
authors: Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.
authors: Jonathan
authors: J
authors: Young
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D006562:Herpes Zoster / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D014645:Herpesvirus 3, Human / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D006685:Hoarseness / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D010612:Pharyngitis / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D012074:Remission Induction; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014775:Virus Activation; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*
chemical_list: D000998:Antiviral Agents; D013256:Steroids; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir
keywords: Cranial neuropathy; Herpes zoster; Larynx; Polymerase chain reaction; Varicella-zoster virus