A case of advanced esophageal cancer with Ramsey Hunt syndrome, which developed to generalized herpes zoster and meningoencephalitis after neoadjuvant chemotherapy

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  • Kozuki Ryotaro
    Department of Gastroenterology Cancer Institute Hospital of Japanese Foundation of Cancer Research
  • Mine Shinji
    Department of Gastroenterology Cancer Institute Hospital of Japanese Foundation of Cancer Research
  • Yamashita Kotaro
    Department of Gastroenterology Cancer Institute Hospital of Japanese Foundation of Cancer Research
  • Okushi Daisuke
    Department of Infectious disease, Cancer Institute Hospital of Japanese Foundation of Cancer Research
  • Sasaki Toshiharu
    Department of Infectious disease, Cancer Institute Hospital of Japanese Foundation of Cancer Research Department of Infectious Diseases, Fujita Health University School of Medicine
  • Okamura Akihiko
    Department of Gastroenterology Cancer Institute Hospital of Japanese Foundation of Cancer Research
  • Yuda Masami
    Department of Gastroenterology Cancer Institute Hospital of Japanese Foundation of Cancer Research
  • Hayami Masaru
    Department of Gastroenterology Cancer Institute Hospital of Japanese Foundation of Cancer Research
  • Imamura Yu
    Department of Gastroenterology Cancer Institute Hospital of Japanese Foundation of Cancer Research
  • Furukawa Keiichi
    Department of Infectious disease, St. Luke’s International Hospital
  • Watanabe Masayuki
    Department of Gastroenterology Cancer Institute Hospital of Japanese Foundation of Cancer Research

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Other Title
  • 術前化学療法中にRamsay Hunt症候群を発症し，播種性帯状疱疹・髄膜脳炎へ重症化をきたした進行食道癌の1例

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Abstract

<p>We report a case of advanced esophageal cancer with Ramsey Hunt syndrome, which developed to generalized her-pes zoster and meningoencephalitis after neoadjuvant chemotherapy. A 70’s female with locally advanced esophageal cancer was admitted to our hospital for treatment. She received two courses of chemotherapy consisted of 5-fluorouracil and cisplatin as a neoadjuvant therapy. After the second course of chemotherapy, headache, reddening of the pinna, facial palsy and eruptions of the body were observed. Cerebrospinal fluid examination revealed menin-goencephalitis. Based on these findings, she was diagnosed as Ramsey Hunt syndrome concomitant with generalized herpes zoster and meningoencephalitis. She was treated with Aciclovir and steroid. Her facial movement and eruptions of the body were recovered. Then, we planned two-stage operation for esophageal cancer. She underwent esophagectomy and esophagostomy first, and then the secondary reconstruction using gastric tube was performed. At 20 days after the esophageal reconstruction, CT revealed multiple lymph nodes and hepatic metastasis, and she died at 36 days after the operation. In this case, Ramsey Hunt syndrome developed to generalized herpes zoster and meningoencephalitis because of immunosuppressive condition. Ramsey Hunt syndrome during chemotherapy should be taken care, as it may rapidly progress to generalized herpes zoster.</p>

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