抜歯後生じた三叉神経第一枝領域の帯状ほう疹 虹彩炎が晩発した症例

Abstract

In spite of the causative organism being identified, the onset mechanism of herpes zoster remains unknown, and until recently there have been no satisfactory therapeutics. Therefore, the form of treatment of this disease had been mainly symptomatic. However, newly developed antiviral agents such as Ara-A, Ara-C, and Acyclovir are showing good results in combating viral disease and we are now in a new age in herpes zoster treatment.A case of post-extraction herpes zoster in the first division of the trigeminal nerve treated by an antiviral agent together with other drugs which showed complete remission, followed by iritis of the left eye is herein reported, and the onset mechanism of herpes zoster subsequent to the extraction is discussed.Under local anesthesia, a 25-year-old female patient, who had an episode of pericoronitis, had an extraction of a completely impacted left lower third molar. Tingling was noted on the left side of her forehead 9 days after the procedure and a vesicular lesion on the erithematous base appeared on the 10th day. Based on a diagnosis of herpes zoster, vitamin B 1 2 and bufexamac ointment were given first, but the symptoms were aggravated by severe pain and vomiting. Then, the patient was administered for 5 days an antiviral agent, Ara-A, 300mg. per day intravenously by drip from 4 days after the onset of the disease. Human immunoglobulin, steroid hormone and antibiotics were also given for 3, 7 and 10 days respectively. Almost all symptoms of the disease such as pain, vesicles and erithema disappeared within 1 week. The elevation of serum CF antibody titer in herpes zoster remained low.Approximately 1 year after discharge a slit-lamp examination of the left eye showed a flare and cells from iritis. Now, there is no sign of iritis but because of the tendency of high ocular tension, the patient is still under observation in the out-patient clinic of the ophthalmology department.According to retrospective study, except for the extraction of left lower third molar, there was no triggering factor such as trauma, fever, attack of other diseases, or excessive fatigue. It is suggested that the extraction in the region of the third division of the trigeminal nerve provided the impulse in the Ggl. trigeminale or in the N. oplithalmicus, reactivating Varicella-Zoster virus and causing dermal bullous eruptions in the region of the first division of the trigeminal nerve. Varicella-Zuster virus might have also caused the iritis because the iris sensory nerve is a branch of the trigeminal nerve.