scholarly journals Clinical report of rare manifestation of Herpes Zoster in the mandibular nerve

2021 ◽  
Vol 10 (4) ◽  
pp. e46010414225
Author(s):  
Victor Teixeira Prest ◽  
Radamés Bezerra Melo ◽  
Carlos Diego Lopes Sá ◽  
Nayara Cristina Monteiro Carneiro ◽  
Ranelle de Souza Bernardino ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Skin Lesions ◽  
Codeine Phosphate ◽  
Clinical Report ◽  
Initial Exposure ◽  
Lower Lip ◽  
Varicella Zoster ◽  
The Face ◽  
Triggering Factor ◽  
Mandibular Region

Herpes zoster (HZ) – a viral infection commonly known as shingles – is caused by reactivation of the varicella-zoster virus (VZV), one of eight known herpes viruses that infect humans. It is ubiquitous and highly contagious, with initial exposure usually occurring during childhood, when it causes chickenpox. The mechanism responsible for reactivating the virus is still not fully understood. However, it appears to be associated with a weakened immune system, with stress also having been identified as a possible triggering factor. Vesicular-bullous lesions on the skin that follow the pathway of a particular nerve are typically the clinical basis for diagnosing HZ with no need for further laboratory testing. The objective of this study is to report a clinical case of a patient, 17 years old, diagnosed with HZ in the trigeminal nerve with involvement of the mandibular branch. There were vesicular-bullous skin lesions in the mesenteric region, the mandibular region and the lower lip, in addition to erythematous lesions on the tongue, with pain in all the affected regions. All lesions were located on the left side of the face and did not exceed the midline. The treatment was performed with acyclovir and pain medication (Paracetamol and Codeine Phosphate, Tylex® 30mg), with complete resolution occurring in 30 days. The patient is undergoing a 6 month outpatient follow-up and did not exhibit any functional sequelae.

scholarly journals Varicella Zoster Virus-Associated Meningitis as a Rebound Varicella Zoster Disease after Antiviral Discontinuation

2021 ◽  
pp. 148-153
Author(s):  
Tetsuko Sato ◽  
Takenobu Yamamoto ◽  
Yumi Aoyama
Keyword(s):  
Herpes Zoster ◽  
Early Diagnosis ◽  
Varicella Zoster Virus ◽  
Immunosuppressive Therapy ◽  
Unusual Case ◽  
Cranial Nerves ◽  
Skin Lesions ◽  
Immunocompromised Patients ◽  
Aggressive Treatment ◽  
Varicella Zoster

Varicella zoster virus (VZV)-associated meningitis is usually progressive and can be fatal, and early diagnosis and aggressive treatment with intravenous antivirals such as acyclovir (ACV) are required in immunocompromised patients. Patients receiving corticosteroids and immunosuppressive therapy have a significantly higher risk of VZV-associated meningitis. In this report, we describe an unusual case of herpes zoster (HZ) in a young woman who was first diagnosed during tapering of prednisone for dermatomyositis. The skin lesions affected the left L2 and L3 dermatomes, which is unusual in VZV-associated meningitis. Despite showing a good rapid response to antivirals, she developed VZV-associated meningitis immediately after discontinuation of ACV. This phenomenon is often called rebound VZV reactivation disease and occurs after discontinuation of antivirals. This case was notable in that the affected dermatomes were distant from the cranial nerves. Thus, progression of HZ to VZV reactivation-associated meningitis can occur even in appropriately treated HZ patients. Continuation of antivirals beyond 1 week in patients on immunosuppressive therapy may be associated with a decreased risk of severe rebound VZV disease, such as VZV-associated meningitis.

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

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lorenzo Stefano Pelloni ◽  
Raffaele Pelloni ◽  
Luca Borradori
Keyword(s):  
Herpes Zoster ◽  
Varicella Zoster Virus ◽  
Trigeminal Nerve ◽  
Dna Amplification ◽  
Immunocompetent Patient ◽  
Varicella Zoster ◽  
Burning Pain ◽  
The Face ◽  
Patients At Risk ◽  
Trigeminal Nerves

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.

scholarly journals Nigerian Female with Skin Lesions in the Leg and Face: Herpetic Sycosis Folliculitis

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Dominique Dilorenzo ◽  
Naganna Channaveeraiah ◽  
Patricia Gilford ◽  
Bruce Deschere
Keyword(s):  
Normal Skin ◽  
The United States ◽  
Skin Lesions ◽  
Unusual Presentation ◽  
Diagnostic Dilemma ◽  
Lower Lip ◽  
Hiv Test ◽  
Mucus Membrane ◽  
The Face ◽  
The Right

Nongenital HSV 1 presents outside the mucus membrane. Our patient had unusual presentation that caused diagnostic dilemma. 30-year-old native Nigerian female coming with fiancée to the United States presented to our service one day after arrival through ER with a lesion on her right ankle. She was diagnosed with cellulitis, started on antibiotics, and admitted to hospital. She had fever of 39.1°C. Head and neck exam showed multiple sized lesions over tongue and palate and inner aspect of lower lip. Abdomen and genital exam was normal. Skin exam showed lesions over the face and lesions over the lateral aspect of the right leg. There was ulcerated lesion over the right lateral malleolus with surrounding erythema and edema. Her tests showed elevated ESR of 98; HIV test was negative; CT scan of the ankle showed no abscess or osteomyelitis. TB quantiferon was indeterminate; AFB stain and culture were negative; HSV IgM was elevated at 1 : 16; RPR was negative; ANA was negative; malaria screen was negative, and blood cultures were negative for bacteria, fungus, and virus. Debrided wound had no growth of bacteria or fungus or virus. This case illustrates the unusual presentation of the HSV1 outside the mucus membrane and how it can be confused with other conditions that required extensive tests. Therapeutic trail with antiviral medications resolved lesions over the leg and face.

scholarly journals Clinical Study on Outcome of Treatment for Herpes Zoster

2021 ◽  
Author(s):  
Kishan Rasubhai Ninama ◽  
Rashmi Samir Mahajan ◽  
Atmakalyani Rashmi Shah ◽  
Apexa Prakash Jain
Keyword(s):  
Herpes Zoster ◽  
Lupus Erythematosus ◽  
De Novo ◽  
Clinical Manifestations ◽  
Pemphigus Vulgaris ◽  
Clinical History ◽  
Skin Lesions ◽  
Enzyme Linked Immunosorbent Assay ◽  
Oral Acyclovir ◽  
Varicella Zoster

Introduction: Herpes Zoster (HZ) is caused by reactivation of Varicella Zoster Virus (VZV). It is characterised by occurrence of grouped vesicles on erythematous base which involves the entire dermatome innervated by a single spinal or cranial sensory ganglion and is associated with radicular pain. Antivirals (Acyclovir, Famciclovir and Valacyclovir) started within 72 hours of onset of lesions are the agents of choice. Aim: To study the clinical manifestations, comorbidities, efficacy and safety of Acyclovir, complications and sequelae associated with HZ. Materials and Methods: A 3-year longitudinal cohort study was conducted in 212 adult patients (>18 years of age) suffering with HZ in the Department of Dermatology, Dhiraj General Hospital, Pipariya, Gujarat, India. In this study 212 patients with HZ were prescribed oral Acyclovir in a dose of 800 mg 5 times a day for 7 days. All patients were analysed in terms of clinical manifestations, pre-existing co-morbidities and incidence of complications. The clinical history and findings were recorded in a prestructured proforma. All patients were subjected to cytological examination (Tzanck smear) and Human immunodeficiency viruses (HIV) testing Enzyme-Linked Immunosorbent Assay (ELISA). Diagnosis was made primarily on the basis of clinical findings and presence of multinucleated giant cells in Tzanck smear. All the patients were treated with Oral Acyclovir. Cases were followed-up fortnightly for six weeks and evaluated for relief of symptoms, treatment outcome and complications/sequelae. Results: Two hundred and twelve cases were studied. One hundred and forty-two cases were in the 4th and 5th decades of life. Sixty-three cases had comorbidities like diabetes mellitus in 31, autoimmune diseases like pemphigus vulgaris, systemic lupus erythematosus, rheumatoid arthritis and inflammatory bowel disease in 19 and AIDS in 8 cases. Five cases had malignancy/lymphomas and were receiving chemotherapy for the same. In the majority, HZ occurred de novo without any comorbidities. The most common dermatomes involved were cervical and thoracic. Out of 212 cases Oral Acyclovir 800 mg was well tolerated by 74. Most common complication was Postherpetic Neuralgia (PHN), seen in 80 cases. Conclusion: The treatment of HZ with Oral Acyclovir 800 mg 5 times a day for 7 days is efficacious for healing of skin lesions and also reduces the chances of PHN if instituted within 72 hours.

scholarly journals An An Unusual Presentation of Varicella Meningitis: A Case Report and Review of the Literature

2019 ◽  
Vol 14 (4) ◽  
pp. e39-e42
Author(s):  
Matthew Patel ◽  
Rachel Bierbrier ◽  
Katina Tzanetos
Keyword(s):  
Herpes Zoster ◽  
Dorsal Root ◽  
Primary Infection ◽  
Acute Infection ◽  
Neurologic Complications ◽  
Review Of The Literature ◽  
Healthy Male ◽  
Varicella Zoster ◽  
The Face ◽  
Zoster Sine Herpete

Varicella Zoster Virus (VZV) primary infection causes chickenpox, often in young children, and is characterized by vesicular lesions on the face, limbs and trunk. In immunocompetent hosts, the infection is usually mild and self-limited. Following infection the virus remains dormant in the dorsal root ganglia but can reactivate, replicate and cause Herpes zoster (shingles), a painful vesicular eruption in a single dermatomal distribution.1, 2 Although Herpes zoster typically presents with this characteristic rash, there are reports of zoster sine herpete herpes zoster without the presence of a rash but with pain.1 Neurologic complications, including meningitis, encephalitis or myelitis can occur with acute infection or reactivation of VZV, but is uncommon in immunocompetent hosts, and even more rare without an exanthema.3 This report describes a case of reactivation VZV meningitis without any viral exanthema in a young healthy male.  

scholarly journals Clinical study of herpes zoster in 109 patients in central referral hospital, Gangtok

2019 ◽  
Vol 5 (4) ◽  
pp. 849
Author(s):  
Rukma L. Sharma ◽  
Rekha Sharma
Keyword(s):  
Herpes Zoster ◽  
Dorsal Root ◽  
Skin Lesions ◽  
Age Group ◽  
Female Ratio ◽  
Varicella Zoster ◽  
Single Nerve ◽  
Male Female Ratio ◽  
The Common

<p class="abstract"><strong>Background:</strong> Herpes zoster results from the reactivation of varicella-zoster virus lying dormant in the dorsal root ganglia following an earlier primary infection (chickenpox), usually in childhood. The reactivation occurs due to multifactorial causes leading to decreased immunity.</p><p class="abstract"><strong>Methods:</strong> This study was conducted on 109 cases of herpes zoster. Patient’s particulars were noted. A detailed history was recorded; morphology, the site and side of skin lesions were recorded. Any other associated diseases were noted.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 109 patients 66 were male and 43 were female. The total of 53 (48.6%) patients were under the age of 40 years and 56 (51.4%) patients above 40 years. Bhutias were affected in highest number (18.4%) followed by Sharma community (15.6%). The ophthalmic division of trigeminal nerve was the most commonly affected single nerve with 13.8% followed by T10 and T7 dermatome at 9.17% and 7.3% respectively. Thoracic nerves the most commonly involved thoracic nerves with 44 cases. Single dermatomal eruptions were found in 55 patients. The dissemination of herpes zoster was although very rare but was present in three patients. Type 2 diabetes mellitus was the common associated systemic illness with 10.09% of patients.</p><p class="abstract"><strong>Conclusions:</strong> From this study it was revealed that both young adults and older age group people were affected almost equally. The male: female ratio was 1.5:1 with Bhutia community being mostly affected. Thoracic dermatome was the most common dermatome involved and in half the patients some form of associated disease noted.</p>

Herpes Zoster and Postherpetic Neuralgia

2018 ◽  
pp. 93-98
Author(s):  
Jianguo Cheng
Keyword(s):  
Herpes Zoster ◽  
Postherpetic Neuralgia ◽  
Dorsal Root ◽  
Skin Lesions ◽  
Intercostal Nerve ◽  
Intrathecal Therapy ◽  
Nerve Blocks ◽  
Varicella Zoster ◽  
Epidural Injections ◽  
History Of

Herpes zoster is caused by reactivation of the latent varicella zoster virus (VZV) that causes chicken pox. VZV remains dormant in the dorsal root and cranial ganglia and can reactivate later in a person’s life and cause herpes zoster, which appears predominantly in older adults, but may also occur in those that are immunocompromised. Postherpetic neuralgia (PHN) is defined as pain in the affected dermatome that is still present 1 month after development of the vesicles. Adults older than 50 should receive the herpes zoster vaccine as part of routine medical care. Shingrix is a new vaccine recently approved and recommended by the FDA, which is a non-live, subunit vaccine. In contrast to Zostavax, Shingrix is 97% effective against shingles and 91% effective against PHN for people 50 and older. The diagnosis of herpes zoster can be made on the basis of characteristic skin lesions and pain and itching in the involved dermatome. During the acute phase, an antiviral given within 72 hours of onset helps reduce pain and complications and shorten the course of the disease. The diagnosis of PHN is based on a history of herpes zoster, typical dermatomal distribution of the pain, and hyperalgesia and/or allodynia on physical examination. First-line pharmacotherapy includes gabapentin or pregabalin, tricyclic antidepressants, and SNRIs. Combination therapies are often necessary. Interventional options such as epidural injections, paravertebral blocks, selective nerve root blocks, sympathetic nerve blocks, intercostal nerve blocks, trigeminal nerve blocks, spinal cord or dorsal root ganglion stimulation, and intrathecal therapy may be considered in refractory cases.

scholarly journals Cutaneous Manifestation of Disseminated Cryptococcosis Mimicking Herpes Zoster

2021 ◽  
pp. 77-81
Author(s):  
Hoon Choi ◽  
Dong Hyun Shim ◽  
Min Sung Kim ◽  
Bong Seok Shin ◽  
Chan Ho Na
Keyword(s):  
Herpes Zoster ◽  
Skin Lesions ◽  
Fungal Culture ◽  
Cutaneous Manifestations ◽  
Systemic Involvement ◽  
Early Markers ◽  
The Face ◽  
Intravenous Amphotericin ◽  
Systemic Symptoms ◽  
Cutaneous Cryptococcosis

Cutaneous cryptococcosis is classified either as localized cutaneous cryptococcosis, in which the lesions are confined to one area of the skin, or as disseminated cryptococcosis, in which cutaneous manifestations are more widespread. We report a case of fatal disseminated cryptococcosis with characteristic cutaneous manifestations. An 84-year-old woman with diabetes presented with crusted plaques and ulcers that were painful, diffuse, and erythematous to crusted and on only the left side of her face, neck, and upper chest. She was referred to our hospital from a local clinic, where herpes zoster had been suspected. She had no specific systemic symptoms. Histological examination of the skin lesion revealed granulomatous reactions and purple to reddish encapsulated spores. Cryptococcus neoformans was identified in fungal culture, and hospitalization was recommended. Oral fluconazole was prescribed, and she was admitted to another hospital. After 2 weeks, the patient's condition deteriorated, and she was transferred to our hospital. C. neoformans antigen was detected in the blood and urine during the evaluation for systemic involvement. The patient was treated with intravenous amphotericin B and fluconazole; however, she died 10 days after admission. Cutaneous manifestations of disseminated cryptococcosis can appear in various forms and mimic molluscum contagiosum, Kaposi's sarcoma, and cellulitis. In this case, the skin lesions occurred on only the left side of the face, neck, and chest, as in herpes zoster. Cutaneous cryptococcosis can occur before the onset of symptoms of systemic involvement; therefore, diagnosis is important. Systemic evaluation may reveal early markers of disseminated cryptococcosis.

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