ROME FOLLOWING COVID-19 VACCINATION - BRITISH MEDICAL JOURNAL

The COVID-19 pandemic has caused profound social and economic upheaval. COVID-19 vaccines promise to prevent infection of the SARS-CoV-2 virus. However, due to their expedited approval, these vaccines need to be vigilantly monitored for their safety. Cases of Bell’s palsy have also been reported after COVID-19 vaccine injection. In two phase III trials of COVID-19 vaccines involving around 38 000 patients, there were seven cases of Bell’s palsy after vaccine compared with one case after receiving placebo.1 2 As the p value was 0.07 and this was a post hoc analysis, no definite association could be inferred.

We recently diagnosed Ramsay Hunt syndrome (RHS) in a 37-year-old previously healthy man. Two days after his first dose of the Pfizer-BioNTech (BNT162b2) vaccine, he noticed fever and a pain in the right ear. Vesicles were then developed in his right ear and canal, together with vertigo, tinnitus and loss of hearing. He complained of facial palsy, tongue numbness and dysgeusia. On examination, he had grade 4 right facial nerve palsy of the lower motor neuron type with right sensorineural hearing loss (figure 1A). There were no other neurological deficits. Vesicles with serous discharge were found over the right concha and external auditory canal (figure 1B). A swab of the exudate was positive for varicella-zoster DNA on PCR, while throat saliva was negative for SARS-COV-2. A CT scan of the brain was normal. The diagnosis was RHS leading to peripheral facial nerve palsy, vestibulocochlear neuropathy and glossopharyngeal somatic sensory neuropathy. As his symptoms developed 2 days after vaccination, we suspected the vaccination triggered RHS. This would be the first reported case of RHS after COVID-19 vaccination.

https://pmj.bmj. com/content/early/2022/01/05/postgradmedj-2021-141022

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