Ramsay Hunt syndrome (RHS) is caused by a reactivation of the varicella zoster virus (VZV). It normally involves the triad of earache, peripheral facial nerve palsy and ipsilateral rash but can present without/with minimal visible rashes. In this case report, a 53-year-old male was admitted to hospital after a week-long headache, right-sided earache and peripheral facial nerve palsy. Vesicular elements were observed on the right side of the tongue. Cerebrospinal fluid (CSF) analysis showed 195 monocytes/mm3, and PCR verified VZV in the CSF. To avoid misdiagnosis, early recognition of the symptoms of RHS and diagnostic workup is advised.
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