Mandibular osteonecrosis and teeth exfoliation after herpes zoster infection in an HIV-inflicted individual

Abstract

Herpes zoster (HZ) infection of the maxillary and mandibular divisions of the trigeminal nerve manifests orally as unilateral vesicular eruption localized to the skin and mucus membrane of the dermatome innervated by the trigeminal nerve. Herpes zoster infection has been observed in immunocompromised states like uncontrolled diabetes, cancer chemotherapy, lymphoproliferative diseases, and recently in HIV-positive patients. There are only a few case reports of osteonecrosis due to HZ in an HIV-positive patient in an Indian population, this being the first in a North Indian population. We propose that osteonecrosis should be considered as a strong indicator of HIV infection, especially in a developing country like India. The present case highlights the complexities which can arise in an HIV-inflicted individual suffering from HZ infection. Early diagnosis of such infections can lead to effective treatment and prevention of complications.