An Unusual Case of Osteonecrosis and Spontaneous Tooth Exfoliation Following Trigeminal Herpes Zoster in a HIV Seropositive Patient

Abstract

Oral lesions associated with human immunodeficiency virus (HIV) are often the first overt clinical features of HIV infection. Reports of HIV-associated herpes zoster infection with alveolar bone necrosis and spontaneous tooth exfoliation are extremely rare, with only four cases reported in the literature. The exact mechanism of osteonecrosis induced by herpes zoster infection remains uncertain. An altered oral environment, decreased host immunity, or immune reconstitution inflammatory syndrome (IRIS) could further compromise the viable periodontal status, leading to alveolar bone necrosis and tooth exfoliation. We report a case of herpes zoster infection involving two divisions of the trigeminal nerve in an HIV-seropositive patient who further manifested with mandibular and maxillary osteonecrosis and spontaneous mandibular and maxillary tooth exfoliation. The occurrence of such infection in immunosuppressed individuals, its etiopathogenesis, and associated clinical features are briefly reviewed and discussed.