Herpes zoster affecting all three divisions of trigeminal nerve in an immunocompetent male: A rare presentation

Naveen, K; Pradeep, A.V.; A, Kumar J S; Hegde, Spandana P; Pai, Varadraj V; Athanikar, Sharatchandra B

doi:10.4103/0019-5154.135548

Cited by 12 publications

(15 citation statements)

References 3 publications

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“…Noteworthy, only anecdotal reports exist about HZ affecting two or three branches of the trigeminal nerve [ 2 – 4 , 6 , 9 ]. In our PubMed search using terms “herpes zoster”, “multidermatomal”, “trigeminal nerve” and “ophthalmicus” we have only identified 5 reports describing cases with HZ affecting two or all three branches of the trigeminal nerve (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…The latter thus warrants a close ophthalmologic evaluation to exclude subsequent ocular involvement. Reactivation of VZV within the maxillary (V2) division may lead to pain and lesions affecting upper lip as well as on the soft and hard palate, while involvement of the mandibular (V3) nerve is associated with manifestations affecting the anterior part of the tongue, floor of oral cavity and buccal mucous membrane [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…In case of atypical presentations as well as in immunosuppressed patients laboratory testing is indicated to confirm the diagnosis of VZV infection. Immunofluorescence microscopy studies for detection of VZV antigens in tissue smears, viral culture or PCR for VZV DNA assays are useful according to the clinical presentation and practical availability [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Herpes zoster of the trigeminal nerve with multi-dermatomal involvement: a case report of an unusual presentation

Pelloni

Borradori

2020

BMC Dermatol

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Herpes zoster of the trigeminal nerve with multi-dermatomal involvement: a case report of an unusual presentation

Pelloni

Borradori

2020

BMC Dermatol

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“…The dermatome affected in the head and neck region along with the area affected along the distribution of the affected nerve is given in Table 1. 9,10 Herpes zoster occurs in three successive stages: prodromal, acute, and chronic neuropathic stages, but few patients do not develop symptoms of all the stages. 1,6 The prodromal (preeruptive stage) presents as pain associated with mild fever, headache, and dysesthesia.…”

Section: Case Reportmentioning

confidence: 99%

Herpes Zoster with Postherpetic Neuralgia involving the Left Maxillary and Mandibular Branch of Trigeminal Nerve

Gupta¹,

Chauhan²,

Sabir³

et al. 2017

IJOCRWEB

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was also present. On examination, cluster of vesicles were present in the left middle and lower third of the face along with cervical lymphadenopathy and redness of skin, thus following the dermatomal rule (Fig. 1). Intraoral examination revealed clusters of shallow ulcers on the left side of the upper buccal mucosa, which were about 3.5 mm in size with erythematous and irregular borders and tissue tags were seen. Shallow ulcers unilaterally on left palatal mucosa were also present (Fig. 2). The left mandibular posterior teeth appeared normal without any dental or periodontal pathology, but tenderness was elicited on percussion with teeth #45, 46. Based on the history of fever, unilateral intense burning pain, and redness on the left side of the face along with the dental pain in the left mandibular posterior teeth, and also the presence of vesicles along the course of the maxillary and mandibular division of trigeminal nerve, it was provisionally diagnosed as HZ of left maxillary and mandibular division of trigeminal nerve. The differential diagnoses included were angioneurotic edema, acute drug eruption and erythema multiforme, pemphigus, and pemphigoid. Investigation included Tzanck smear, in which there were numerous lymphocytes, multinucleated giant cells, with intranuclear inclusion bodies. Differentiation of HZ and herpes simplex infection was confirmed by polymerase chain reaction (PCR). There was elevation in the levels of immunoglobulin (Ig)G and IgM antibodies against VZV. Varicella zoster virus IgM level was 23.9 μ/mL and VZV IgG level was greater than 155 μ/mL, which was suggestive of acute infection of HZ. Patient was treated with tablet valacyclovir thrice daily for 15 days and also tablet gabapentin once daily for 15 days, and 0.5% acyclovir cream topically for five times a day. The patient was reviewed after 15 days, showed healing of all the vesicles along with scaring, but persistence pain in the dermatome supplied by the affected nerve was suggestive of PHN (Figs 3 and 4). Patient was then advised to continue tablet gabapentin for another 15 days following which the pain subsided in a month. DISCUSSION Herpes zoster also named as zona or shingles is a common viral disease caused by the reactivation of VZV. Varicella zoster virus first enters the host and infects the cells of the 1,2 Reader, 3 Private Practitioner, 4,5 Lecturer

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“…3 Herpes zoster (HZ) ile ilişkili en yaygın komplikasyon post herpetik nevraljidir (PHN). 4 Bu olgu sunumuyla alveolar kemikte osteonekroz, dişte devitalizasyon gibi eşlik ettiği komplikasyonlarla birlikte nadir görülen veya birden fazla dermatomu tutan ve PHN'nin geliştiği 5,6 , intraoral veya ekstraoral bölgede görülen, trigeminal siniri tutan HZ'e ait iki farklı olgunun tedavi, takip ve prognozları tartışılarak muayene bulgularına ve komplikasyonlarına dikkat çekmek istenmiştir. Olgu sunumuna katılmış her iki hastadan da sözel ve yazılı onam alınmıştır.…”

Section: Introductionunclassified

Trigeminal sinirin sol maksiller ve mandibular dallarını tutan, osteonekroz veya post herpetik nevraljinin eşlik ettiği iki Herpes zoster olgusu

Koçak¹,

Turhal²,

Tuğsel³

2017

Mersin Üniversitesi Sağlık Bilimleri Dergisi

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Amaç: Herpes zoster; gangliyonlarda latent kalmış varisella zoster virüsünün reaktivasyonu sonucunda ortaya çıkan viral bir hastalıktır. Bu olgu sunumuyla, diş hekimliğinde nadiren karşılaşılan ve trigeminal siniri tutan Herpes zoster enfeksiyonunda komplikasyonların eşlik ettiği iki olgunun tedavi ve prognozlarının değerlendirimesi amaçlanmıştır. Olgu: İlk olguda, hemifasyal ağrılı, yüzün sol bölgesinde vezikülleri bulunan bir kadın hasta kliniğimize başvurdu. Hastaya oral antiviral tedavi başlandı ve lezyonları geriledi. Sonrasında post herpetik nevralji gelişti ve ağrı kontrolü için pregabalin reçete edildi. İkinci olguda ise sol maksiller molar bölgesinde bir ay süren yanma şikayeti ve hiperestezi ile bir erkek hasta kliniğimize başvurdu. Muayene sırasında; hastada vezikülobüllöz lezyonlar, alveoler kemikte osteonekroz ve sol maksiller birinci molar dişte devitalizasyon olduğu saptandı. Her iki olguya Herpes zoster tanısı konuldu ve tedavi edildi. Sonuç: Herpes zoster tedavi edilmediğinde, dişlerin devitalizasyonuna ve eksfoliasyonuna, alveoler kemiğin osteonekrozuna ve post herpetik nevraljiye yol açabilen komplikasyonlar göstermektedir.

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Herpes zoster affecting all three divisions of trigeminal nerve in an immunocompetent male: A rare presentation

Cited by 12 publications

References 3 publications

Herpes zoster of the trigeminal nerve with multi-dermatomal involvement: a case report of an unusual presentation

Herpes zoster of the trigeminal nerve with multi-dermatomal involvement: a case report of an unusual presentation

Herpes Zoster with Postherpetic Neuralgia involving the Left Maxillary and Mandibular Branch of Trigeminal Nerve

Trigeminal sinirin sol maksiller ve mandibular dallarını tutan, osteonekroz veya post herpetik nevraljinin eşlik ettiği iki Herpes zoster olgusu

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