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ASCT, Shingles, Ramsey Hunt Syndrome

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“…short-term complications of Ramsay Hunt syndrome include corneal abrasion and exposure keratopathy, depression and social anxiety, and transmission of chickenpox to unvaccinated or immunocompromised close contacts.”

Hi David- I had an Autologous Stem Cell Transplant (ASCT)  in Jan 2019 and was told that I should get childhood immunizations because the ASCT wiped out any protections I had.  I wasn’t interested.

I’m asking because I had a severe case of shingles  that had me in the hospital for 10 days unable to eat or drink and gave me Ramsey Hunt Syndrome as well.

I have recently wondered if the two were related and if there is something that I should do regarding immunizations after an ASCT.

Let me know, thanks.

If I understand your question, you are thinking through several different issues. I will try to address each.

I believe it is standard for ASCT patients to be told to get all vaccinations again post ASCT. Patients undergoing either/or an

  • Autologous stem cell transplant or
  • Allogeneic stem cell transplant

have their immune systems wiped out and grow a new immune system. Based on what I have read in online forums, some patients get new vaccinations, some don’t. I never did after my ASCT.

My understanding of shingles is that if the patient has the herpes-zoster virus (chickenpox as a kid), once their immune system is weakened post chemo (aggressive chemo from your ASCT), the virus can surface. I too suffered an outbreak of shingles a few months after I completed my ASCT. Very painful…

To your question- if I understand the linked info below, Ramsey-Hunt syndrome is a “late complication” of varicella-zoster virus.  Varicella-zoster is the virus that causes a shingles outbreak. 

If I understand the events- stem cell transplant increases your risk of a herpes-zoster outbreak aka shingles which increases your risk of Ramsey-Hunt syndrome. 

I believe the standard treatment is to undergo antibiotics. My oncologist prescribed acyclovir. My shingles outbreak resolved in a couple of weeks once I began acyclovir. I believe patients now take acyclovir as a preventative now before they have an ASCT.

I have to think that you are wondering if the shingles vaccine would prevent any, all future outbreaks? I don’t know, of course, but I have to believe there is a good possibility that the vaccine prevents each.

I certainly think it is worth asking a specialist. Not a GP but a specialist.

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

I am linking the posts below because the one concept linking cancer with therapies and side effects is inflammation-

Herpes Zoster Oticus

“Herpes zoster virus, also known as shingles, results from the reactivation of latent varicella-zoster virus, which infiltrates the sensory ganglia during varicella. Herpes zoster oticus (HZ oticus), also known as Ramsay Hunt syndrome, is a viral infection of the inner, middle, and external ear caused by spread of the varicella-zoster virus to the facial nerves…”

Ramsay Hunt Syndrome

“Ramsay Hunt syndrome, also known as herpes zoster oticus, is a late complication of varicella-zoster virus infection that results in inflammation of the geniculate ganglion of cranial nerve VII. Ramsay Hunt is a clinical diagnosis and classically is described as a triad of ipsilateral facial paralysis, otalgia, and vesicles near the ear and auditory canal. Diagnosis is often missed or delayed, which can lead to an increased incidence of long-term complications. The condition is self-limiting, but treatment is targeted at decreasing the total duration of the illness as well as providing analgesia and preventing the complications that can occur. This activity reviews the role of the interprofessional team in the diagnosis and treatment of Ramsay Hunt syndrome…

Treatment / Management-

Herpes zoster is generally self-limiting in nature. Therefore, the main goals of treatment are to decrease the incidence of late complications, including spastic facial paralysis and postherpetic neuralgia. Multiple studies have shown a significant decrease in long-term complications with the use of oral antivirals and steroids.

It is unclear, however, whether these medications decrease the length or severity of acute symptoms.

  • Acyclovir,
  • valacyclovir, and
  • famciclovir

have all been studied and found effective. Acyclovir, 500 mg five times a day, is usually the most affordable option. Valacyclovir, 1000 mg three times a day, is easier for most patients to take and appears to be more effective, at least in Bell’s palsy. Another option is famciclovir, 500 mg three times a day, which also appears to be more effective than acyclovir.


Other than the presenting symptoms of pain, rash, facial paralysis, dysgeusia, hearing loss, tinnitus, vertigo, hoarseness, dysarthria, and others mentioned above, short-term complications of Ramsay Hunt syndrome include corneal abrasion and exposure keratopathy, depression and social anxiety, and transmission of chickenpox to unvaccinated or immunocompromised close contacts.

While flaccid paralysis in the long-term is unlikely, the development of synkinesis is very common. Other long-term complications include postherpetic neuralgia, scarring from the vesicles, and persistent depression and/or social anxiety due to loss of facial function…

Enhancing Healthcare Team Outcomes

Ramsay Hunt syndrome affects patients in myriad ways,

  • with pain,
  • paralysis,
  • cochleovestibular symptoms,
  • and behavioral health concerns

all occurring commonly in the acute period. In the long term, while most patients do recover the majority of their premorbid function when managed appropriately, pain, facial dysfunction, scarring, and behavioral health concerns may all persist.

For this reason, optimal patient outcomes occur when healthcare teams include members with expertise across a broad range of specialties.

In the short term, primary care, otolaryngology, neurology, ophthalmology, and psychology/psychiatry are often required.

In the long-term, plastic surgery or otolaryngology, pain management, ophthalmology, speech or physical therapy, and psychology/psychiatry may be needed.

Patients who develop synkinesis may require regular visits over the course of years and years with a physician or nurse who can administer botulinum toxin injections; it is critical to surround these patients with an experienced interprofessional team early on in the treatment process in order to provide them the care and support they need to maximize their quality of life outcomes.[Level 1]…”



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