Herpes zoster-encefalitis: een diagnostische uitdaging bij de geriatrische patiënt

Herpes zoster encephalitis: a diagnostic challenge in a geriatric patient Reactivation of the varicella zoster virus (VZV) is a prevalent disease and is - in addition to the typical vesicular rash - responsible for rare neurological conditions. Older people form a major group of concern, given the increasing risk of VZV reactivation at a higher age together with a higher risk of complications. Herpes zoster encephalitis is a rare but serious complication which often presents atypically, delaying the diagnostic process. In this article, the medical history of a patient with herpes encephalitis without the typical clinical and biochemical signs of infection is presented. This patient also suffered from Ramsay Hunt syndrome, another rare complication of VZV, characterized by vesicular rash in the ear and ipsilateral peripheral facial paralysis. Both diseases are briefly reviewed and the potential benefits of vaccination are discussed.

Frozen overnight: Acute orbital apex syndrome caused by aspergillosis

Purpose to describe a rare case of orbital apex syndrome caused by aspergillosis with acute presentation. Case description retrospective case report of a 70-year-old man who developed unilateral ophthalmoplegia overnight. He was initially given the diagnosis of suspect Tolosa-Hunt syndrome, but biopsy of the involved tissue showed aspergillosis. Conclusion orbital apex syndrome caused by fungal disease is a life-threatening condition that should be promptly diagnosed and treated. It may present acutely and should not be misdiagnosed as Tolosa-Hunt syndrome. To our knowledge this is the first such case report in the English ophthalmic language Literature.

Ramsey Hunt syndrome in the child: case report and treatment approach

Herpes zoster is a manifestation of the reactivation of an infection after chickenpox. One of the manifestations of herpes zoster is Ramsey Hunt syndrome, which develops when the ganglion of the VII pair of cranial nerves is involved in process. Diagnosis of Ramsey Hunt syndrome is often based on a combination of a rash in the outer ear and peripheral paresis of the facial muscles. The article describes a rare clinical case of herpes zoster in a child without clinical signs of immunodeficiency, with the development of unilateral paralysis of the facial muscles, pleocytosis in the cerebrospinal fluid. Therapy was performed with a combination of acyclovir and high doses of methylprednisolone with a good clinical effect. It is first mentioning of deviations in the immune status (decreased concentration of the number of markers of naive T‑lymphocytes (TREC)) were revealed, which could be associated with the development of herpes zoster in a child.

Ramsay Hunt Syndrome in a Patient with Ulcerative Colitis Treated with Infliximab

Ramsay Hunt syndrome is a rare complication of herpes zoster that results from reactivation of varicella-zoster virus in the geniculate ganglion of the VII cranial nerve. Immunosuppression can lead to reactivation of latent varicella-zoster virus, resulting in herpes zoster. Here, we present a case of Ramsay Hunt syndrome in a patient with ulcerative colitis under treatment with infliximab.