OROFACIAL HERPES ZOSTER: A CASE REPORT

Herpes zoster, more commonly known as shingles, is a reactivation of the Varicella zoster virus that entered the cutaneous nerve endings during an earlier episode of chicken pox, travelled to the dorsal root ganglia, and remained in a latent form. Herpes zoster probably results most often from a failure of the immune system to contain latent virus replication. Whether other factors such as radiation, physical trauma, medications, other infections, or stress can also trigger zoster has not been determined with certainty.

Herpes zoster is a sporadic disease with an estimated life time incidence of 10-20%. The incidence of herpes zoster is up to 15 times higher in HIV infected patients than in unifected patients and as many as 25% of patients with Hodgkin's lymphoma develop herpes zoster. The incidence of herpes zoster infection in the general population has been reported to be 5.4%. Herpes zoster infection typically occurs in individuals older than 45 years of age, with the highest incidence among persons 60-90 years old.

In oro-facial herpes zoster, toothaceh may be the presenting symptom. Oral manifestations of herpes zoster such as devitalized teeth, internal resorption, abnormal development of permanent teeth, spontaneous exfoliation of teeth and necrosis of maxilla. Herpes zoster affecting the oral and maxillofacial region may pose a significant diagnostic challenge and should be considered in the differential diagnosis of those presenting with atypical odontalgia.

CASE REPORT

A 53 year old male patient came to dental hospital with the complaint of ulcerations over the left side of the face and mouth since 3 days. History revealed that the patient had fever and severe throat infection a week ago. Then he had burning sensation in the left side of the face as well as in the oral cavity. Gradually vesicles appeared 4 days back and then those vesicles ruptured to form lcers which were very painful. All the ulcers were limited to the face and oral cavity of the left side only. Medical history was non contributory except for the fact that the patient suffered from chicken pox in the childhood.

 Hepes Zoster

On examination multiple irregular shallow ulcerations and crusts are seen on the lips and the peri-oral skin on the left side of the face not crossing the midline. Intra-orally multiple shallow ulcerations, with erythematous irregular borders with tissue tags are seen on the buccal mucosa, palate and the labial mucosa unilaterally on the left side. No dysphagia or odynophagia was reported. There were no other skin lesions accompanying the oro-facial lesions.

Investigations included Tzanck smear, which revealed multi-nucleated giant celss. Serum immunoglobulin levels, herpes simplex virus (HSV) antigen detection and viral culture were not done due to lack of facilities. The patient was prescribed oral acyclovir (800 mg five times a day for 10 days), with and healing of lesions can be seen after 5 days of the treatment. The patient showed remarkable improvement in the lesions and had shown no signs of recurrence in 3 months follow up period.