Dilemma in Diagnosing Herpes Zoster with Prodromal Odontalgia in Immunocompetent Patient: A Case Report

Abstract

Herpes Zoster (HZ) is an acute viral infection characterized by painful unilateral vesicular lesions, generally occurs in immunocompromised conditions, and progresses through three stages i.e., prodromal, active, and chronic stages. Odontalgia may occur when trigeminal nerve branches are involved during this prodromal stage. More than 53% of doctors have difficulty in diagnosing HZ on the prodromal stage before the emergence of the skin eruption. This report describes the HZ infection affecting all three branches of the trigeminal nerve which causes odontalgia on the prodromal stage. A-62-year-old male referred with the complaint of painful oral ulcers, multiple vesicles and crusts with swelling and pain on his left side of the face. Previously, it was only confined to the lips but gradually spreads to the eyes followed by odontalgia and pain on the left side of mandible. The diagnosis of herpes zoster affecting three branches of trigeminal nerves was determined from the presence of unilateral lesions on the skin and oral cavity. The lesions healed completely after two months. Odontalgia in trigeminal HZ that occurs in the prodromal stage can pose a dilemma, be misdiagnosed, and become a diagnostic challenge for dentists. The presence of an unidentified cause of odontalgia should be an alarming sign of HZ infection, especially in the elderly