A 41-year-old male with past medical history of anxiety and depression who presented with a six days history of subjective fever, progressive worsening dysphagia, hoarseness, right-sided headache, ear and jaw pain. Was initially seen by his PCP and was treated for a possible otitis media with antibiotics. However, he continued to get worse for which he was subsequently seen by an otolaryngologist who diagnosed him with right vocal cord paralysis. He was then presented to the emergency for further evaluation. Besides basic labs and blood cultures that were unremarkable, he underwent a lumbar puncture that showed lymphocytic pleocytosis and slightly elevated protein and was positive Varicella-Zoster virus (VZV) PCR. In addition, CT head, CTA head and neck, and contrast enhanced MRI head were found to be unremarkable. He was diagnosed with VZV meningitis, Ramsey hunt syndrome due a lesion in his right ear and vocal cord paralysis. He was treated with acyclovir, gabapentin and amitriptyline for herpetic neuralgia. The patient was started on nectar thick diet as recommended by the dysphagia team. The patient improved significantly with this treatment and a repeated fiberoptic endoscopic evaluation of swallowing (FEES) showed no vocal cord paralysis a few days later. This is a unique and rare case of VZV meningitis who presented with vocal cord paralysis from involvement of recurrent laryngeal nerve, a rarely reported entity.