A 57-year-old man developed 3 days of left facial pain and swelling with left-sided hearing loss followed by a painful, unilateral, erythematous, and vesicular rash on the left anterior two-thirds of the tongue, external auditory canal, lip, and face typical of varicella-zoster virus reactivation (figure). Reactivation in the geniculate ganglion or facial nerve is uncommon and typically causes tongue and auricular lesions or facial palsy and was described by Hunt in 1907.(1) The patient received IV acyclovir and oral prednisone with rapid improvement in pain and resolution of lesions and improvement of hearing over 1 month.