A Case of Zoster Sine Herpete of the Trigeminal Nerve

Abstract

Varicella-zoster virus reactivation causes zoster (shingles), a syndrome characterized by severe pain and a vesicular rash. The present report details a case of varicella-zoster virus reactivation of the maxillary and mandibular division of the right trigeminal nerve without evidence of vesicular rash (zoster sine herpete). It is difficult to identify owing to no typical clinical signs such as vesicular eruption. Zoster sine herpete of the trigeminal nerve, in particular, is rarely reported. In this case, the diagnosis was based on clinical findings and was supported by the demonstration of an immunoglobulin G antibody. Zoster sine herpete of the trigeminal nerve, in particular, should be considered in patients with severe facial pain over specific dermatomes, if they do not demonstrate appreciable findings of traumatic neuropathy, tumor or herpes zoster.

Herpes Zoster Infections (HZIs): Case Series

“…Occasionally, dermatomal pain of herpes zoster infections (HZIs) might occur without appearance of rashes being referred to as zoster sine herpete. It is difficult to identify this condition due to absent obvious clinical signs (Kasahara et al, 2011). Oral lesions occur with trigeminal nerve involvement.…”

“…Following primary varicella zoster virus (VZV) infection, VZV remains latent in the sensory nerve ganglion. The re-activation of the virus may take place years to decades after the primary infection of VZV (Kasahara et al, 2011). Herpes Zoster Infections (HZIs) are more common in people with reduced cell mediated immunity.…”

Zoster sine herpete: a review

“…However, why the pain intensity is higher in ZSH patients is unknown. The authors thought that in ZSH patients, the VZV replication may take place mainly the in sensory ganglia and nerve root, and the innate epidermal immune response reduced the production of interferon-α, tumor necrosis factor-α and interleukin-1α, and prevented the spread of the VZV in the skin [34]. In addition, memory T cells containing skin-homing receptors may cooperate with the innate epidermal immune response, and limit the VZV reactivation and replication in the skin.…”

Prophylaxis and treatment of acute and chronic postherpetic neuralgia

“…Kasahara i wsp. [21] opisali przypadek ZSH w obrębie nerwu trójdzielnego, który charakteryzował się dolegliwościami bólowymi szczęki i żuchwy po stronie prawej. Rozpoznanie oparli na badaniu klinicznym oraz obecności u pacjenta przeciwciał anty-VZV w klasie IgG.…”

“…Rozpoznanie oparli na badaniu klinicznym oraz obecności u pacjenta przeciwciał anty-VZV w klasie IgG. Zoster sine herpete nerwu trójdzielnego należy rozważyć szczególnie u pacjentów z ciężkim bólem twarzy w obrębie konkretnych dermatomów po wykluczeniu neuropatii pourazowej oraz nowotworu [21]. Przypadek ZSH, potwierdzony badaniami serologicznymi, z towarzyszącym neuropatycznym bólem powłok jamy brzusznej obserwowali Schuchmann i wsp.…”