Herpes zoster vasculitis presenting as giant cell arteritis with bilateral internuclear ophthalmoplegia

PURPOSE: To present a case of herpes zoster vasculitis presenting as giant cell arteritis. DESIGN: Interventional case report. METHODS: A 77-year-old woman presented with sudden onset of diplopia associated with temple headaches and a previous history of herpes zoster ophthalmicus. A temporal artery biopsy was obtained and in-situ hybridization performed for herpes zoster DNA. RESULTS: The patient presented with a bilateral internuclear ophthalmoplegia. Initial diagnostic evaluation, including erythrocyte sedimentation rate, C-reactive protein, and temporal artery biopsy, was consistent with giant cell arteritis. However, in-situ hybridization of the temporal artery specimen was positive for herpes zoster DNA. CONCLUSIONS: Herpes zoster vasculitis may mimic giant cell arteritis and should be considered in the differential of any patient with presumed giant cell arteritis with suspicious findings, central nervous system involvement, or previous herpes zoster infection.     

Herpes zoster ophthalmicus.

BACKGROUND: We examined the literature for the latest information on diagnosis and management of herpes zoster, and compiled a representative database. METHODS: Using search engines and library resources, we reviewed pathology, epidemiology, pathophysiology, differential diagnosis, and management. RESULTS: The varicella zoster virus is a member of the herpes virus family that produces an infection through direct contact with active skin lesions or airborne droplets. The infection resides latent in the trigeminal ganglion until reactivated, often affecting the sensory nerve, skin, eye, and adnexa. CONCLUSION: The varicella zoster virus has the potential to severely disrupt the structures of the eye. Patients less than 50 years of age should be referred for systemic workup to rule out an immunocompromised state. In general, management is often palliative and/or geared toward specific sequelae.     

Herpes zoster conjunctival ulceration.

A 70 year old man acquired a herps zoster infection of the ophthalmic division of his right trigeminal nerve. During the course of the illness he developed the rare complication of a cojunctival ulcer. It is suggested that the ulceration may be the result of an ischemic ischemic vasculitis.     

Herpes zoster ophthalmicus

Introduction : Herpes zoster is a common disease which may cause serious ocular sequelae when it affects the trigeminal nerve. Although involvement of the nasociliary branch of the first division of the trigeminal nerve is well recognised to be associated with serious and direct ocular morbidity, the need for careful long‐term follow‐up of cases of frontal branch involvement is perhaps less well known. Methods : The pathogenesis, epidemiology, risk factors, clinical course and treatment of herpes zoster are discussed with emphasis on trigeminal nerve involvement. A case report is presented which illustrates the importance of continuing management when the frontal branch of the trigeminal nerve is affected. Discussion : Clinical guidelines are suggested for optometric management of these cases in cooperation with medical practitioners.     

Herpes zoster ophthalmicus

Herpes zoster ophthalmicus occurs worldwide, usually in healthy adults, but, increasingly in patients who are immunocompromised. After primary varicella infection (chickenpox), the virus lies dormant in the sensory ganglion until it becomes reactivated as zoster. Involvement of the ophthalmic branch of the trigeminal nerve is characterized early by corneal dysesthesia and dendritiform keratopathy, and these are self-limited. However, smoldering disease may cause pathological changes in the ocular structures through direct invasion of virus, secondary inflammation, and alterations of autoimmune mechanisms. Antiviral agents have demonstrated some success in resolving early signs and symptoms, but their role in preventing and treating late complications remains to be fully studied. Until a definitive antiviral agent is established, the benefits of steroid use in certain acute inflammatory processes outweigh its risk of reducing host immunity. Corneal complications of herpes zoster ophthalmicus sometimes require surgical intervention.     

Exposed hydroxyapatite orbital implants. Report of six cases.

Six patients with complications of primary or secondary hydroxyapatite implants were studied. Complications included socket infection and/or conjunctival dehiscence. Complications were detected during regular follow-up examinations, and various treatment approaches were used. The hydroxyapatite implant exposure occurred 4 to 6 weeks (mean, 4.5 weeks) after implantation. Three of the six implants were wrapped in preserved donor sclera before implantation. One of the implants showed wide exposure and chronic infection and was removed. In two cases, scleral patch grafts with a conjunctival pedicle graft were performed, resulting in successful coverage of the implant without further conjunctival dehiscence. In one of the patients, a Tenon's conjunctival flap was advanced to cover the defect, and was unsuccessful with the spicules of the hydroxyapatite eroding through the vascular flap after 1 month. Three of the patients demonstrate a persistent conjunctival epithelial defect. These three patients with chronically exposed hydroxyapatite have remained stable with follow-up intervals ranging from 8 to 12 months. Early exposure of hydroxyapatite orbital implants is a potential problem despite meticulous technique. Implant coverage is difficult, although chronic exposure seems to be tolerated often in the hydroxyapatite orbital implant without migration or extrusion.     

Herpes zoster optic neuritis

Herpes zoster (HZ) is an acute infection caused by reactivation of the latent varicella-zoster virus [1]. Herpes zoster ophthalmicus (HZO) occurs when inflammation spreads from the ganglion of Gasser to the ophthalmic branch of the trigeminal nerve. Optic neuritis, a very rare sequela of HZO [2–4], can occur simultaneously to the acute vesicular skin eruption or, more frequently, as a postherpetic complication. We report on a 74-year-old woman who presented with HZ optic neuritis 45 days after developing an incompletely treated bout of trigeminal HZ, characterized only by pruritus. It is important to value the non-specific manifestations of cutaneous HZ in the prodromal phase, so as to offer timely and appropriate treatment.     

Herpes zoster virus infection

PURPOSE OF REVIEW: The virology, pathophysiology, and treatment of the varicella zoster virus (VZV) have been investigated for many years now. Infection with VZV has different ramifications for people of different ages and immune status. The various aspects of VZV disease make it difficult to treat. Selected aspects of VZV disease that pertain to ocular disease are presented. RECENT FINDINGS: The risk factors for VZV disease in the different age spectrums and with concomitant immunodeficiencies have been further clarified. Studies suggest that the VZV may persist for prolonged periods on the cornea after herpes zoster ophthalmicus (HZO). Herpes Simplex Virus (HSV) or VZV may cause many cases of idiopathic uveitis with sectoral iris atrophy. The different patterns of retinal disease caused by VZV may relate to the immune status. Systemic antiviral medications for herpes zoster should be instituted within 72 hours of the rash but could be used later. Systemic antivirals combined with systemic corticosteroids improve the early quality of life in HZ patients. Postherpetic neuralgia is not prevented by early systemic antivirals or corticosteroids. Present systemic antivirals are all effective, but Famvir offers the best dosing schedule. The VZV vaccine is effective but there are some issues that suggest the need for a different vaccination regimen. SUMMARY: Further research must be performed on the clinical and therapeutic aspects of the VZV disease. Although both the vaccine and systemic antivirals have brought tremendous improvements, the disease persists. Therapy lessens but does not eliminate many of the complications. The disease may manifest in unpredictable patterns in this era of vaccination.     

Herpes zoster ophthalmicus: a medical review.

Patients with herpes zoster undergo extensive screening to detect underlying malignant disease which is compromising their immunity. In a retrospective survey of 1000 patients with herpes zoster ophthalmicus 12 patients had malignant disease which was known on presentation. No new cases were detected or discovered on follow-up. Three patients developed a disseminated rash, but none of these had an underlying malignant disease.