Herpes zoster involving the abducens and vagus nerves without typical skin rash

Abstract

Rationale: Herpes zoster is characterized by unilateral vesicular eruption and it most often affects the trigeminal nerve. We would like to report a rare case of abducens and vagus nerves palsy caused by varicella zoster virus (VZV) without the typical vesicular rash. Patient concerns: A 71-year-old woman presented with diplopia. Three days previously, she had experienced sore throat and hoarseness. Diagnosis: At presentation, the prism cover test revealed esotropia of 10 prism diopters at primary gaze, and abduction was restricted in the right eye. No vesicular rash was observed on the patient's face, and magnetic resonance imaging of the brain showed no pathology. Flexible fiberoptic laryngoscopy revealed multiple ulcerations on the right side of the larynx—from the epiglottis to the arytenoid. After 1 day of hospitalization, a diffuse skin rash occurred on the patient's trunk, and polymerase chain reaction for VZV DNA was positive at the skin lesion. The patient was diagnosed as having herpes zoster associated with vagus and sixth nerve palsy. Intervention and outcomes: She received famciclovir at a dose of 500 mg 3 times daily for 7 days and coadministered methylprednisolone. At the 4-month follow-up, her diplopia and eye movement had resolved completely. Lessons: In patients with abducens nerve palsy without typical vesicular lesion, herpes zoster may not be detected early. In that case, systemic examination is very important for diagnosing herpes zoster.

A Case Report of Acute Laryngitis with Auricular Lesion: Herpes Zoster Infection with Isolated Vagus Nerve Involvement and Vocal Fold Paresis

“…3) Since the main manifestation of herpes zoster (HZ) infection is a skin or mucosal lesion appearing in an area that is innervated by an infected nerve, the location of vesicles indicates which nerve is affected by VZV infection. 5,6) Thus, VHZ was suspected in this patient because of the observation of vesicular lesions in the ipsilateral auricle and larynx. In addition, accompanying ipsilateral vocal fold paresis made VHZ more likely based on the function of the vagus nerve.…”

“…7) In the literature review, VZV infection of cranial nerve generally present as multiple cranial neuropathies, and isolated vagus nerve involvement of HZ has been reported only a few cases. 5,8) Thus, understanding the functions of the vagus nerve is critical for differential diagnosis of VHZ or acute laryngitis. Attention should be given to patients infected with HZ to minimize the risk of permanent nerve dysfunction, postherpetic neuralgia, and motor nerve palsy.…”

Herpes zoster in an immunocompetent host with C6 dermatitis and abducens nerve palsy

“…Its reactivation results in a painful vesicular rash and potential neurologic complications, including cranial neuropathies, meningitis, and even death. 1,2 One such manifestation is herpes zoster ophthalmicus (HZO), in which involvement of the ophthalmic division (V1) of the trigeminal nerve (CN V) can cause a host of related ophthalmologic problems including keratitis, uveitis, and retinitis. Though the trigeminal, facial, and vestibulocochlear nerves are most often affected, those innervating the extraocular muscles (oculomotor, trochlear, and abducens nerves) can also be involved.…”

“…The treatment of HZV with cranial nerve palsy is somewhat controversial, though systemic antiviral therapy, with or without systemic corticosteroids, is the mainstay of therapy. 1,2,4 The prognosis for spontaneous recovery of extraocular muscle function is favorable, with an estimated recovery time of 6À8 weeks. 2,3 In summary, clinicians ought to recognize the possibility of disseminated zoster in those with cranial nerve palsy and accompanying rash in an atypical distribution because prompt diagnosis and treatment can help mitigate further viral proliferation, meningitis, and death.…”

Herpes Ir Influenza Virusinių Infekcijų Neurologinės Komplikacijos

“…Skirtas famcikloviras 500 mg 3 kartus per dieną septynias dienas ir metilprednizolonas į veną. Praėjus keturiems mėnesiams, diplopija ir akių judesių sutrikimai išnyko [31]. 64 metų moteriai po galvos, kairės ausies ir gerklės skausmo pasireiškė ūminis kairės pusės n.glossopharyngeus, n.vagus, n,accessorius ir n. hypoglossus paralyžius.…”