An extremely unusual presentation of varicella zoster viral infection of cranial nerves mimicking Garcin syndrome

We report a patient with the varicella zoster viral (VZV) infection of multiple cranial nerves mimicking Garcin syndrome, who initially presented with Ramsay Hunt syndrome (herpes zoster oticus). A 78-year-old man showed left facial palsy with zosteric eruptions in his left auricle and dysphagia, followed by left total ophthalmoplegia. His serum anti-VZV antibody titer was elevated. Cerebrospinal fluid examination revealed pleocytosis with a slightly elevated protein level. He was treated with intravenous acyclovir and corticosteroids. His tongue weakness resolved, and then ocular movement improved. The improvement of facial palsy and swallowing difficulty was delayed. VZV infection should be considered even in patients who show unilateral multiple cranial neuropathy mimicking Garcin syndrome because it is treatable.