Herein, we report a case of ZSH that occurred in a patient with sudden hearing loss and cervical spine abnormalities. As ZSH is uncommon, it is usually not suspected, especially when accompanied by other problems, until other common causes for the symptoms are ruled out. When ZSH involves the ophthalmic division of the trigeminal nerve, it causes symptoms such as trigeminal neuralgia and headache. Ophthalmic ZSH was first described by Ross in 1949. Misdiagnosis of ZSH can lead to prolonged severe neuropathic pain, nerve palsy, myelitis, pneumonitis, otitis externa, ophthalmic complications, and fatal complications, such as encephalitis or stroke. ZSH has been defined as pain in a dermatomal distribution without a rash and is more difficult to diagnose than typical HZ because there is no vesicular eruption. Zoster sine herpete (ZSH) is an atypical clinical manifestation of HZ. The causes of atypical facial pain and headache are variable, and one of them is herpes zoster (HZ).
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