Vera O, Vallejo R, Zúñiga G, Murcia C, Arango A

Language: Spanish
References: 12
Page:
PDF size: 294.00 Kb.

ABSTRACT

Introduction: Cranial nerve involvement is one of the complications of varicella-zoster virus reactivation; however, presenting complete ophthalmoplegia is unusual.
Objective: To describe the case of an immunocompetent adult who developed an infectious ophthalmoplegia due to varicella-zoster virus reactivation.
Clinical case: The patient presented complete alteration of the extraocular muscle motility of the left eye with pupillary reflex compromise, decrease in visual acuity and concomitant trigeminal neuralgia. The patient did not present signs or symptoms suggestive of encephalitis or meningitis. Days before the ophthalmoplegia, vesicles appeared in the left frontal and periorbital regions. Cerebrospinal fluid (CSF) examination with FilmArray® meningitis/encephalitis panel documented positivity for varicella-zoster virus only. The patient was treated with acyclovir, steroids and neuromodulators, resulting in partial improvement of his symptoms after two weeks. The discussion was based on the few case reports found in different databases.
Conclusions: This case broadens the clinical and therapeutic understanding of an unusual manifestation of this common disease, which combines pathologic involvement of several cranial nerves due to varicella-zoster virus reactivation.

REFERENCES

1. Cohen JI. Herpes Zoster. N Engl J Med. 2013;369(3):255-63. DOI: https://doi.org/10.1056/NEJMcp13026741.

2. Kennedy PG, Mogensen TH. Determinants of neurological syndromes caused by varicella zoster virus (VZV). J Neurovirol. 2020;26(4):482-95. DOI: https://doi.org/10.1007/s13365-020-00857-w2.

3. Tsau PW, Liao MF, Hsu JL, Hsu HC, Peng CH, Lin YC, et al. Clinical Presentations and Outcome Studies of Cranial Nerve Involvement in Herpes Zoster Infection: A Retrospective Single-Center Analysis. J Clin Med. 2020;9(4):946-54. DOI: https://doi.org/10.3390/jcm90409463.

4. Kedar S, Jayagopal LN, Berger JR. Neurological and Ophthalmological Manifestations of Varicella Zoster Virus. J Neuroophthalmol. 2019;39(2):220-31. DOI: https://doi.org/10.1097/WNO.00000000000007214.

5. Pupić-Bakrač J, Pupić-Bakrač A, Terkeš V, Baraka I. Cranial polyneuropathy caused by herpes zoster infection: a retrospective single-center analysis. Eur Arch Otorhinolaryngol. 2021;278(2):517-23. DOI: https://doi.org/10.1007/s00405-020-06279-y5.

6. Sanjay S, Chan EWE, Gopal L, Hegde SR, Chang BCM. Complete unilateral ophthalmoplegia in herpes zoster ophthalmicus. J Neuro-Ophthalmology. 2009;29(4):325-37. DOI: https://doi.org/10.1097/WNO.0b013e3181c2d07e6.

7. Chen LK, Arai H, Chen LY, Chou MY, Djauzi S, Dong B, et al. Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific. BMC Infectious Diseases. 2017;17(1):213-51. DOI: https://doi.org/10.1186/s12879-017-2198-y7.

8. Ying XH, Wagle AM, Tan L, Sanjay S, Hedge SR, Chew YC, et al. A rare case of herpes zoster ophthalmicus with complete ophthalmoplegia. J Am Geriatr Soc. 2008;56(11):2160-2. DOI: https://doi.org/10.1111/j.1532-5415.2008.01996.x8.

9. Kaufman AR, Myers EM, Moster ML, Stanley J, Kline LB, Golnik KC. Herpes Zoster Optic Neuropathy. J Neuro-Ophthalmology. 2018;38(2):179-89. DOI: https://doi.org/10.1097/WNO.00000000000006079.

10. Skripuletz T, Pars K, Schulte A, Schwenkenbecher P, Yildiz Ö, Ganzenmueller T, et al. Varicella zoster virus infections in neurological patients: a clinical study. BMC Infect Dis. 2018;18(1). DOI: https://doi.org/10.1186/s12879-018-3137-210.

11. Persson A, Bergström T, Lindh M, Namvar L, Studahl M. Varicella-zoster virus CNS disease-Viral load, clinical manifestations and sequels. J Clin Virol. 2009;46(3):249-53. DOI: https://doi.org/10.1016/j.jcv.2009.07.01411.

12. Li A, Tandon A, Dinkin M, Oliveira C. The Use of Systemic Steroids in the Treatment of Herpes Zoster Ophthalmicus-Related Ophthalmoplegia: Case Report and Case Meta-analysis. Am J Ophthalmol. 2021;223:241-5. DOI: https://doi.org/10.1016/j.ajo.2020.10.02212.