Herpes zoster of the trigeminal nerve with multi-dermatomal involvement: a case report of an unusual presentation
- PDF / 818,435 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 38 Downloads / 185 Views
CASE REPORT
Open Access
Herpes zoster of the trigeminal nerve with multi-dermatomal involvement: a case report of an unusual presentation Lorenzo Stefano Pelloni1,2* , Raffaele Pelloni3 and Luca Borradori1
Abstract Background: Herpes zoster, also known as shingles, results from reactivation of the varicella-zoster virus. It commonly presents with burning pain and vesicular lesions with unilateral distribution and affects the thoracic and cervical sites in up to 60 and 20% of cases, respectively. The branches of the trigeminal nerves are affected in up to 20% of cases. Multidermatomal involvement of the trigeminal nerves has been only anecdotally described in immunocompetent subjects. Case presentation: A 71-year-old previously healthy male presented with grouped vesicular and impetiginized lesions with crusts on the left half of the face of two-weeks duration. The lesions first developed on the left nasal tip and progressively worsened with unilateral appearance of vesicular lesions on the left forehead, face, ala nasi, nasal vestibulum and columella, as well as on the left side of hard and soft palate. The affected edematous erythematous areas corresponded to the distribution of the left ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerve, including the infraorbital and nasopalatine nerves of the maxillary branch responsible for the oral cavity involvement. Viral DNA amplification by polymerase chain reaction confirmed the presence of Varicella zoster virus. The patient was started on oral valaciclovir with rapid recovery. Conclusions: Among immunocompetent patients, herpes zoster is considered a self-limited localized infection. Our observation provides a rare but paradigmatic example of herpes zoster with involvement of both the ophthalmic and maxillary divisions of the trigeminal nerve in an immunocompetent patient. Immunocompetence status and age-specific screening should be warranted in case of atypical involvement and according to the patient’s history, while treatment with antiviral drugs should be rapidily initiated in patients at risk. Keywords: Herpes zoster, Trigeminal nerve, Multidermatomal involvement
Background Herpes zoster (HZ), also known as shingles, results from reactivation of the varicella-zoster virus (VZV). It is estimated that there are approximately 1 million new cases per year in the USA [1]. It commonly presents with burning pain and vesicular lesions with unilateral * Correspondence: [email protected] 1 Department of Dermatology, University Hospital of Bern, Inselspital, Bern, Switzerland 2 ENT, Lugano, Switzerland Full list of author information is available at the end of the article
distribution. HZ commonly affects the thoracic and cervical sites in up to 60 and 20% of cases, respectively. Furthermore, the branches of the trigeminal nerves are involved in up to 20% of cases [1, 2]. Multidermatomal involvement of the trigeminal nerves has been rarely described in immunocompetent subjects [1–4]. We here present a striking case of HZ with involvement of op
Data Loading...
