A patient present painful vesicles in ear, and tongue. He is also complaining of facial weakness and hearing loss. Dignosis is –
**Core Concept**
Herpes zoster, caused by the reactivation of varicella-zoster virus (VZV), presents with characteristic cutaneous manifestations and can involve cranial nerves, leading to neurological symptoms.
**Why the Correct Answer is Right**
The patient's symptoms suggest Herpes zoster oticus (Ramsay Hunt syndrome type 2), which is caused by the reactivation of VZV in the geniculate ganglion. This results in inflammation of the facial nerve (cranial nerve VII) and its associated ganglion, leading to the characteristic symptoms of painful vesicles in the ear, facial weakness, and hearing loss. The involvement of the geniculate ganglion explains the symptoms.
**Why Each Wrong Option is Incorrect**
**Option A:** Herpes simplex virus (HSV) typically causes oral or genital herpes, not painful vesicles in the ear and tongue.
**Option B:** Lyme disease is caused by Borrelia burgdorferi and can cause neurological symptoms, but it does not typically present with painful vesicles in the ear and tongue.
**Option C:** Mumps is a viral infection that primarily affects the parotid gland and can cause facial weakness, but it does not typically present with painful vesicles in the ear and tongue.
**Clinical Pearl / High-Yield Fact**
Herpes zoster oticus can be diagnosed by the presence of painful vesicles in the ear and the involvement of cranial nerve VII, which can be confirmed by electromyography (EMG) or nerve conduction studies (NCS).
**Correct Answer:** C.