HERPES ZOSTER OPHTALMICUS IN AN IMMUNOCOMPETENT PATIENT

Abstract

HZO (Herpes Zoster Ophthalmicus) is defined as the reactivation of VZV (Varicella Zoster Virus) in the ophthalmic branch of the trigeminal nerve, leading to the appearance of well-demarcated erythematousvesicular lesions along the dermatome. Antiviral therapy is mandatory and preferably initiated within the first 72 hours of the rash onset, as it is most effective in preventing ocular involvement. Raising awareness of the importance of early diagnosis and management of herpes zoster ophthalmicus, with the involvement of an ophthalmologist is critical in limiting visual morbidity. We present a 40-year-old patient without significant medical history or background treatment, immunocompetent, whose symptoms began suddenly with a few erythematous- vesicular lesions on the left fronto-parietal scalp preceded by burning pain and hyperesthesia. At her first medical exam, she was recommended antiviral treatment with oral acyclovir and cortisone. She was admitted in our clinic 48 hours from the onset, with the extension of the lesions to the left forehead and peri-orbital, periorbital itching, left occipital hypoesthesia, and painful pre-, retro-auricular, and left latero-cervical lymphadenopathy. Intravenous antiviral treatment with acyclovir was started (7 days), and corticosteroid therapy was discontinued, with a favorable outcome. The particularity of this case lies in the reactivation of VZV in an immunocompetent patient, with a sudden onset and rapid progression. Additionally, the initial suspicion of diagnosis was not supported by the subsequent course of the disease, and corticosteroid treatment was discontinued. It is important to perform a differential diagnosis correlated with each stage of the disease to avoid inappropriate therapeutic management, which can have long-term adverse effects on the patient.