Ramsay Hunt Syndrome in Patients with Underlying Metabolic Disorders: A Case Series of Two Clinical Presentations
Anil S Harugop*, Suprita Savadatti, Ayushi Mehta and Binsi Thomas
Department of ENT, KLE Prabhakar Kore Hospital, Belagavi, Karnataka, India
*Corresponding Author: Anil S Harugop, Department of ENT, KLE Prabhakar Kore Hospital, Belagavi, Karnataka, India.
Received:
July 29, 2025; Published: August 23, 2025
Abstract
Herpes zoster results from reactivation of latent Varicella-Zoster Virus (VZV), typically presenting with a dermatomal vesicular rash and possible post-herpetic neuralgia. Ramsay Hunt syndrome (RHS), a rare form of VZV reactivation involving the geniculate ganglion, presents with unilateral peripheral facial palsy and a vesicular ear rash. Prompt diagnosis is crucial to differentiate it from other neurological conditions. It commonly affects the elderly or immunocompromised. Herein we describe a case series of two cases with atypical RHS presentation, featuring isolated peripheral facial paralysis and a vesicular rash in the retroauricular area with metabolic disorders.
Keywords: Varicella-Zoster Virus; Ramsay Hunt Syndrome; Retroauricular Area; Vesicular Rash; Hypothyroidism; Diabetes Mellitus
References
- Rose S., et al. “Zero Trust Architecture (NIST Special Publication 800‑207)”. National Institute of Standards and Technology (2020).
- Hasan M. “Enhancing Enterprise Security with Zero Trust Architecture”. arXiv preprint arXiv:2410.18291 (2024).
- Gambo M L and Almulhem A. “Zero Trust Architecture: A Systematic Literature Review”. arXiv preprint arXiv:2503.11659 (2025).
- Nasiruzzaman M., et al. “The Evolution of Zero Trust Architecture (ZTA) from Concept to Implementation”. arXiv preprint arXiv:2504.11984 (2025).
- Lin J and Wang X. “Zero trust identity verification using blockchain for IoT”. Sensors 12 (2023): 5278.
- Matiushin I and Korkhov V. “Continuous authentication methods for zero‑trust cybersecurity architecture”. In ICCSA 2023 Workshops (LNCS) 14205 (2023): 334-
- Zhang Y., et al. “Micro‑segmentation enforcement in Zero Trust networks”. IEEE Transactions on Network and Service Management1 (2022): 123-135.
- Patel S., et al. “Enhancing Zero Trust with behavioural analytics”. Journal of Cybersecurity Analytics2 (2024): 75-91.
- Brown C and Thomas K. “Insider threat mitigation in Zero Trust environments”. Information Security Journal: A Global Perspective2 (2022): 100-113.
- Herrera M and Singh T. “Policy tuning for Zero Trust micro‑segmentation”. Journal of Network Optimization 1 (2023): 55-74.
- Antwi F and Bello M. “Identity orchestration in Zero Trust environments”. Identity Systems Journal2 (2024): 60-78.
- Li X and Zhao J. “A Zero Trust architecture for secure healthcare systems”. IEEE Access 9 (2021): 140589-140599.
- Lund B., et al. “Zero trust cybersecurity: procedures & considerations”. SSRN (2024).
- Zhang T and Kim H. “Deep learning-based intrusion detection in Zero Trust”. Computer Networks 173 (2020): 107231.
- Chen M., et al. “Intelligent security for edge computing under ZTA”. Future Generation Computer Systems 97 (2019): 302-312.
- Ghasemshirazi S., et al. “Zero Trust: applications, challenges, and opportunities”. arXiv preprint arXiv:2309.03582 (2023).
- Park J and Lambert N. “Real-time trust scoring in ZTA”. Access Control Intelligence Journal2 (2022): 45-63.
- Sullivan D and Patel N. “Behavioural baselines for anomaly detection”. Security Analytics Quarterly1 (2023): 30-49.
- Johnson M and Singh R. “Policy abstraction tools in ZTA”. Security Operations Insights2 (2023): 64-82.
- Ojo O and Akinowo O. “ZTA adoption in critical infrastructure: challenges & benefits”. Risk Analysis Journal (2025).
- Zohaib S , et al. “Zero Trust VPN (ZT‑VPN): framework for hybrid work”. Information 15.11 (2024): 734.
- Ramezanpour M and Jagannath S. “Cryptographic enhancements in ZTA”. Journal of Applied Cryptography1 (2022): 12-31.
- Adahman M and Jagannath S. “Machine learning in IAM for Zero Trust”. Computers & Security 116 (2022): 102650.
- Subhash B and Kumar P. “Managing ZTA policy complexity”. Security Policy Quarterly 6 (3 (2024): 100-118.
- Ahmed L and Brown S. “Training for ZTA culture shift”. Journal of Cybersecurity Education2 (2021): 68-87.
- Perez R and Singh P. “Monitoring trust policy drift in ZTA”. Policy Management Review3 (2022): 100-118.
- Hwang J and Murphy T. “Phased rollout models for ZTA adoption”. Journal of Security Adoption Strategies 9 (2 (2023): 80-99.
- Campos A and Wilson E. “Identity orchestration in ZTA”. Journal of Identity Systems2 (2022): 60-78.
- Lee K and Martinez F. “Governance in hybrid deployments under ZTA”. Unified Security Journal1 (2023): 41-60.
- Antwi F., et al. “Zero Trust theory & applications”. Information Security Review 14 (2024): 30-49.
- Vasconcelos A. “Success patterns in ZTA micro segmentation”. GigaOM Technical Report (2025).
- Gellert P., et al. “Organizational factors in ZTA implementation”. Journal of Strategic IT Management (2024).
- Ahmed T., et al. “Adaptive access control in ZTA”. IEEE Trans. Dependable Secure Comput. 20.8 (2023): 3150-3162.
- Murthy V R K. “ZTA deployment in SMBs: A risk mitigation study”. Risk Analysis Journal (2024).
- Liu H and Edwards T. “Edge device compliance verification in ZTA. Edge Security Review3 (2023): 90-108.
- Tucker A and Liu Z. “ZTA in government and critical infrastructure”. Critical Systems Security Review3 (2022): 123-142.
- Chen Y., et al. “Dynamic trust-based access control in cloud ZTA”. Springer Open Cybersecurity, 2, Article 24 (2024).
- Cruz R., et al. “Continuous mutual lightweight authentication in IoT ZTA”. Journal of Advanced Inf. Tech., 2022 (2023): 6367579.
- Ekata Team. “Zero-trust identity and continuous authentication”. Ekata Technical Brief (2023).
- “Continuous authentication: The core of Zero Trust”. StateTech Magazine (2023).
- Patel A and Tamboli V. “Zero Trust in IoT: Emerging authentication tech”. Symmetry8 (2024): 993.
- QuickLaunch Team. “The birth and evolution of Zero Trust”. Industry Article (2024).
- Tripwire Team. “Role of ZTA in enhancing SSO security”. State of Security Blog (2023).
- Smith D. “Zero Trust challenges and maturity factors”. Computers and Security (2024).
- Ghasemshirazi S and Shirvani G. “ZTA in dynamic cloud‑IoT environments”. IEEE IoT Journal7 (2024): 6123-6134.
- Connelly S., et al. “ZTA education and culture shift”. Journal of Cybersecurity Education2 (2021): 68-87.
- Brown J and Kumar P. “Review of trust policy drift in ZTA”. Policy Management Review3 (2023): 100-118.
- Hou X and Wu F. “Adaptive trust scoring for continuous ZTA”. International Journal of Trust Management, 5.1 (2024): 35-52.
- Zheng L and Chen Y. “ZTA for securing hybrid workforces”. Journal of Remote Access Security3 (2023): 112-130.
- Hughes M and Reed J. “Micro‑segmentation for lateral threat containment”. Cyber Threat Review 15 (2024): 98-
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