Association between Facial Nerve Palsy and Herpes Zoster infection in patients with immunocompromised state

Abstract

Objective: To examine the relationship between patients' immunocompromised state and clinical severity and polycrani-al nerve involvement and recovery outcomes in groups of patients with Ramsay Hunt Syndrome (RHS) at tertiary hospi-tals of Sindh, Pakistan.
Methodology: This retrospective cohort study included136 confirmed RHS cases during January to December 2024. Patients were classified as immunocompromised (n=41) and immunocompetent (n=95). Data included demographics, comorbidities, initial House-Brackmann facial nerve grade, polycranial nerve involvement, timing of initiation of antiviral therapy, and 6-month recovery. Statistical analysis consisted of Mann-Whitney U, chi-square, and odds ratios.
Results: Patients with immunocompromised RHS were found to be significantly older (mean age, 61.2 vs 48.6 years; p<0.001) and had a higher prevalence of diabetes (58.5% vs 14.7%; p<0.001) and HIV (22% vs 0%; p<0.001). Severe initial facial nerve palsy (House-Brackmann Grade V/VI) was more prevalent in immunocompromised patients com-pared to immunocompetent patients (68.3% vs 36.8%; p<0.001). Polycranial nerve involvement was encountered in 56.1% of immunocompromised patients, whereas polycranial nerve involvement was identified in only 27.4% of immunocompetent patients (OR 2.71; p=0.001). Initiating antiviral therapy early (≤72 hours) in immunocompromised patients significantly improved rates of complete recovery at six months (57.1% vs 25.0% with delayed therapy; p=0.029).
Conclusion: Immunocompromised RHS patients are older, have more severe facial palsy, have a greater risk of polycra-nial nerve involvement, and recover at a slower pace, particularly if treated late.
Key words: Ramsay Hunt Syndrome, Immunocompromised, facial palsy, Herpes Zoster.