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Adolescent with painful vesicular otitis and vertigo
  1. Ester Conversano1,
  2. Giorgio Cozzi2,
  3. Federico Poropat2,
  4. Alberto Di Mascio1,
  5. Simona Salis1,
  6. Domenico Leonardo Grasso2,
  7. Egidio Barbi1,2
  1. 1 Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
  2. 2 Department of Pediatrics, Institute for Maternal and Child Health - IRCCS ‘Burlo Garofolo’, Trieste, Italy
  1. Correspondence to Dr Ester Conversano, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste 34149, Italy; esterconversano{at}

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A 15-year-old girl presented with left ear pain and vertigo, exacerbated by head movements. She described vertigo as a sensation of motion of the environment. Physical examination showed hyperaemia and oedema of the auricle and of the external auditory canal. Persistent, spontaneous, horizontal, grade II right-beating nystagmus, under Frenzel’s glasses, was noted. Bedside examination of vestibulospinal reflexes (Romberg test, past pointing test, tandem, walking and stepping tests) showed a shifting towards the left, indicating a static imbalance. Oral therapy with ciprofloxacin at 20 mg/kg in two doses was started. Three days later, ear pain and vertigo persisted and worsened. On re-evaluation, a painful vesicular and crusty rash in the left auditory canal and auricle was noted (figure 1).

Figure 1

Vesicular and crostous lesions of the auditory canal and concha, with oedema and hyperaemia of the ear, pathognomonic of varicella zoster virus reactivation.

Question 1

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  • Contributors EC drafted the initial manuscript and approved the final manuscript as submitted. GC, FP, ADM, DLG and SS contributed to achieving the clinical diagnosis of the case. GC and EB critically reviewed the manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding None declared.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.