**6.1 Case 5: lower cranial polyneuropathy**

A 64-year-old woman developed acute paralysis of the IX, X, XI, and XII nerves on the left side after experiencing pain in the left ear and throat. CSF examination revealed lymphocytic pleocytosis and elevated protein levels. VZV DNA was detected with PCR using CSF. She was diagnosed with cranial polyneuropathy due to VZV reactivation. After the oral administration of antiviral agent and steroid, all signs and symptoms dramatically improved. Notably, there was no evidence of cutaneous or mucosal rash during the entire course of the disease. VZV reactivation should be included in the differential diagnosis of multiple cranial nerve palsies, particularly with pain and even without rash.
