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Ikhlef M, Saadi S. Ophthalmic herpes zoster in an immunocompetent five-year-old child. J Fr Ophtalmol 2024; 47:103951. [PMID: 37806934 DOI: 10.1016/j.jfo.2023.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE The goal of this clinical case is to report a case of ophthalmic zoster in a five-year-old boy and to insist on the relevance of early antiviral treatment (aciclovir) so as to minimize corneal affection and preserve visual function. OBSERVATION We report the case of a five-year-old boy of preschool age with no notable pathological history who came for consultation with a painful eruption affecting the forehead, the upper eyelid, the nose. The clinical examination showed many erythematous vesicles affecting the left hemi-face. The diagnosis of ophthalmic zoster has been retained. Minimum biological laboratory assessment is normal. The treatment was local antiseptic and systemic aciclovir with high dose for ten days. The evolution was favorable. Zoster is rare in children. The ophthalmic form is exceptional. The diagnosis is clinical and should mention some bladdery lesions grouped in bunches with a disposition which follows a metamere. It can be responsible for serious ocular complications. CONCLUSION The particularity of our observation is the presence of zoster in an immunocompetent child and the ophthalmic localization, that remains exceptional in children.
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Affiliation(s)
- M Ikhlef
- University of Bejaia, Targa ouzemour, Béjaïa, Algeria.
| | - S Saadi
- University of Bejaia, Targa ouzemour, Béjaïa, Algeria
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Hu F, Peng X, Wang H. Unilateral Acute Retinal Necrosis with Contralateral Non-necrotizing Herpetic Uveitis. Ocul Immunol Inflamm 2024; 32:351-354. [PMID: 38330153 DOI: 10.1080/09273948.2020.1860232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/01/2020] [Indexed: 02/10/2024]
Abstract
PURPOSE The objective of this study is to report a case of unilateral acute retinal necrosis (ARN) with contralateral eye presenting as non-necrotizing herpetic uveitis. CASE REPORTS Case 1: A 48-year-old female presented at our clinic with blurred vision in the right eye for 7 days. She was diagnosed with ARN in the left eye 2 weeks ago. Ophthalmic examination revealed reduced visual acuity in the right eye (20/33) with the presence of optic disc swelling and macular exudation without peripheral necrotic lesions. With systemic antiviral therapy, optic disc swelling of the right eye vanished gradually, and the visual acuity improved to 20/20. Loss of retinal nerve fiber layer (RNFL) and decreased retinal thickness in the corresponding area occurred during follow-up. CONCLUSION Non-necrotizing herpetic uveitis may occur in the contralateral eye of unilateral ARN under rare conditions. Structure abnormities, including loss of RNFL and focal decreased retinal thickness, are irretrievable.
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Affiliation(s)
- Feng Hu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Ophthalmology, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Xiaoyan Peng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Ophthalmology, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Hong Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Walia A, Sun Y, Acharya NR. Risk of Herpes Zoster Ophthalmicus Recurrence After Recombinant Zoster Vaccination. JAMA Ophthalmol 2024; 142:249-256. [PMID: 38358762 PMCID: PMC10870220 DOI: 10.1001/jamaophthalmol.2023.6830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/10/2023] [Indexed: 02/16/2024]
Abstract
Importance The recombinant zoster vaccine (RZV) is currently recommended for immunocompetent adults aged 50 years or older and immunocompromised adults aged 19 years or older and is effective in preventing herpes zoster ophthalmicus (HZO). However, questions about the safety of RZV in patients with a history of HZO remain. Objective To evaluate whether there is an increased risk of HZO recurrence after RZV in patients with a history of HZO. Design, Setting, and Participants This retrospective cohort study used medical and outpatient pharmacy claims data for commercial and Medicare Advantage enrollees from the Optum Labs Data Warehouse. Patients with incident HZO from January 1, 2010, to December 31, 2021, were identified; the study period ended on March 31, 2022. The vaccinated group consisted of patients with at least 1 dose of RZV more than 90 days following the initial HZO diagnosis. The unvaccinated group consisted of patients without any record of RZV in the study period. Vaccinated and unvaccinated patients were matched using exact k:1 matching without replacement. Exposure Recombinant zoster vaccination. Main Outcomes and Measures The main outcome was the number of HZO recurrences with and without RZV exposure. Results A total of 16 408 patients were included in the matched analysis, of whom 12 762 were unvaccinated (7806 [61.2%] female; mean [SD] age at diagnosis, 68.8 [10.3] years) and 3646 were vaccinated (2268 [62.2%] female; mean [SD] age at diagnosis, 67.4 [9.8] years). Within the primary risk period of 56 days after the index date (ie, the start of follow-up for the outcome), the incidence of HZO recurrence after any RZV exposure was 37.7 per 1000 person-years compared with 26.2 per 1000 person-years in the unexposed group. After controlling for race and ethnicity, inpatient stays, emergency department visits, concomitant vaccines, and eye care practitioner visits, the association between vaccination status and HZO exacerbation in the primary risk period had an adjusted hazard ratio for any RZV exposure of 1.64 (95% CI, 1.01-2.67; P = .04). Conclusions and Relevance In this study, RZV exposure was associated with a higher likelihood of HZO recurrence in patients with a history of HZO compared with no RZV exposure. These findings support consideration that patients with a history of HZO may benefit from monitoring after receiving RZV in case of HZO recurrence.
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Affiliation(s)
- Anushka Walia
- School of Medicine, University of California, San Francisco
| | - Yuwei Sun
- F.I. Proctor Foundation, University of California, San Francisco
| | - Nisha R Acharya
- F.I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Noguchi K, Makino S. Isolated Paralytic Mydriasis in Herpes Zoster Ophthalmicus. Klin Monbl Augenheilkd 2024; 241:195-196. [PMID: 37054991 DOI: 10.1055/a-2073-0819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Affiliation(s)
- Kumiko Noguchi
- Ophthalmology, Jichi Medical University, Shimotsuke, Japan
| | - Shinji Makino
- Ophthalmology, Jichi Medical University, Shimotsuke, Japan
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Kelly MM, Long S, Saade C, Tung GA. Postherpetic Neuralgia After Herpes Zoster Ophthalmicus. R I Med J (2013) 2024; 107:32-36. [PMID: 38166075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Affiliation(s)
- Mary M Kelly
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI
| | - Sokunvichet Long
- Department of Internal Medicine, Rhode Island Hospital, Providence, RI
| | - Celine Saade
- Department of Ophthalmology, Brown University, Providence, RI
| | - Glenn A Tung
- Professor of Diagnostic Imaging, Brown University, Providence, RI
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Ng JM, Hsiao CH. Bilateral herpes zoster ophthalmicus in an immunocompetent patient. Eur J Ophthalmol 2024; 34:NP32-NP34. [PMID: 37211648 DOI: 10.1177/11206721231177895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Bilateral herpes zoster ophthalmicus (HZO) is rare. We report a case of an immunocompetent patient with nonsimultaneous attacks of HZO in both eyes. CASE DESCRIPTION A 71-year-old female patient complained of blurred vision in the left eye for 1 week, which was treated with topical antiglaucomatous drugs due to elevated intraocular pressure. She denied any systemic diseases, but HZO had manifested as a rash with a crust over the right forehead skin 3 months earlier. Slit-lamp examination revealed localized corneal edema with keratin precipitates and mild anterior chamber reaction. Suspecting corneal endotheliitis, we performed aqueous tapping for detecting viral DNA, including cytomegalovirus, herpes simplex virus, and varicella zoster virus (VZV) DNA, through polymerase chain reaction (PCR) testing, but the PCR results were negative for all viruses. The endotheliitis resolved well after treatment with topical prednisolone acetate. However, the patient's blurred vision recurred in the left eye 2 months later. A dendritiform lesion on the left cornea was detected, and corneal scraping for PCR testing revealed VZV DNA. The lesion disappeared with antiviral treatment. CONCLUSIONS Bilateral HZO is uncommon, particularly in immunocompetent patients. When in doubt, physicians should perform tests such as PCR testing to help establish a definite diagnosis.
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Affiliation(s)
- Jack Min Ng
- Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Hsi Hsiao
- Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
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Beuran DI, Macovei ML, Boca IR. Multiple ocular manifestations in a patient diagnosed with herpes zoster ophthalmicus: case report. Rom J Ophthalmol 2024; 68:81-86. [PMID: 38617727 PMCID: PMC11007559 DOI: 10.22336/rjo.2024.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/16/2024] Open
Abstract
Objective: Our purpose was to present a case of a patient diagnosed with herpes zoster ophthalmicus with multiple ocular manifestations. Case presentation: A 70-year-old Caucasian male presented to the hospital for headache and skin hyperesthesia on the scalp and forehead on the left side. The diagnoses of herpes zoster ophthalmicus and acute conjunctivitis were made for the left eye. The patient was followed up for 6 months and during that period the following diagnoses were made for the same eye: peripheral sterile corneal infiltrates, episcleritis, and hypertensive anterior uveitis. Discussions: Herpes zoster ophthalmicus occurs when the reactivation of the dormant virus involves the ophthalmic division of the trigeminal nerve. The most frequent ocular presentations are conjunctivitis, keratitis, uveitis, episcleritis, and scleritis. The standard therapy consists of antivirals, such as acyclovir, valacyclovir, and famciclovir to limit the replication of the virus. The patient's risk factors, the course of treatment, and the severity of the disease, all affect the prognosis, which is highly variable. Prevention of the disease consists of vaccination with one of the following two vaccines, Zostavax and Shingrix. Conclusions: Final visual acuity for the left eye remained 1 despite numerous manifestations of the disease. Abbreviations: VZV = Varicella-zoster virus, BCVA = best-corrected visual acuity, OU = both eyes, OD = right eye, OS = left eye, IOP = intraocular pressure, NCT = non-contact tonometer, ZVX = Zostavax vaccine.
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Affiliation(s)
- David-Ionuț Beuran
- Department of Ophthalmology, „Dr. Carol Davila” Central Military University Emergency Hospital, Bucharest, Romania
| | - Mioara-Laura Macovei
- Department of Ophthalmology, „Dr. Carol Davila” Central Military University Emergency Hospital, Bucharest, Romania
- „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Thng ZX, Putera I, Testi I, Chan K, Westcott M, Chee SP, Dick AD, Kempen JH, Bodaghi B, Thorne JE, Barisani-Asenbauer T, de Smet MD, Smith JR, McCluskey P, La Distia Nora R, Jabs DA, de Boer JH, Sen HN, Goldstein DA, Khairallah M, Davis JL, Rosenbaum JT, Jones NP, Nguyen QD, Pavesio C, Agrawal R, Gupta V. The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 1-global current practice patterns for the management of Herpes Simplex Virus and Varicella Zoster Virus anterior uveitis. Eye (Lond) 2024; 38:61-67. [PMID: 37419957 PMCID: PMC10764303 DOI: 10.1038/s41433-023-02630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023] Open
Abstract
AIMS To present current expert practice patterns and to formulate a consensus for the management of HSV and VZV AU by uveitis specialists worldwide. METHODS A two-round online modified Delphi survey with masking of the study team was conducted. Responses were collected from 76 international uveitis experts from 21 countries. Current practices in the diagnosis and treatment of HSV and VZV AU were identified. A working group (The Infectious Uveitis Treatment Algorithm Network [TITAN]) developed data into consensus guidelines. Consensus is defined as a particular response towards a specific question meeting ≥75% of agreement or IQR ≤ 1 when a Likert scale is used. RESULTS Unilaterality, increased intraocular pressure (IOP), decreased corneal sensation and diffuse or sectoral iris atrophy are quite specific for HSV or VZV AU from consensus opinion. Sectoral iris atrophy is characteristic of HSV AU. Treatment initiation is highly variable, but most experts preferred valacyclovir owing to simpler dosing. Topical corticosteroids and beta-blockers should be used if necessary. Resolution of inflammation and normalisation of IOP are clinical endpoints. CONCLUSIONS Consensus was reached on several aspects of diagnosis, choice of initial treatment, and treatment endpoints for HSV and VZV AU. Treatment duration and management of recurrences varied between experts.
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Affiliation(s)
- Zheng Xian Thng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilaria Testi
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Kevin Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Mark Westcott
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Soon-Phaik Chee
- Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrew D Dick
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
- University of Bristol, Bristol, UK
- UCL Institute of Ophthalmology, London, UK
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School, and Schepens Eye Research Institute, Boston, MA, USA
- Sight for Souls, Fort Myers, FL, USA
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital, and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Bahram Bodaghi
- Department of Ophthalmology, IHU FOReSIGHT, Sorbonne-APHP, 47-83 bd de l'Hopital, 75013, Paris, France
| | - Jennifer E Thorne
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Talin Barisani-Asenbauer
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Marc D de Smet
- Department of Ophthalmology, Leiden University, Leiden, The Netherlands
- MIOS sa, Lausanne, Switzerland
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, SA, Australia
- Queensland Eye Institute, Brisbane, QLD, Australia
| | - Peter McCluskey
- Department of Ophthalmology, Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Douglas A Jabs
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joke H de Boer
- Department of Ophthalmology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Debra A Goldstein
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Janet L Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James T Rosenbaum
- Oregon Health and Science University, Portland, OR, USA
- Legacy Devers Eye Institute, Portland, OR, USA
| | - Nicholas P Jones
- School of Biological Sciences, University of Manchester, Manchester, UK
| | | | - Carlos Pavesio
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
- University of Bristol, Bristol, UK
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Duke NUS Medical School, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Lu A, Sun Y, Porco TC, Arnold BF, Acharya NR. Practice Patterns in the Initial Management of Herpes Zoster Ophthalmicus in the United States. Cornea 2024; 43:6-12. [PMID: 36952627 PMCID: PMC10517067 DOI: 10.1097/ico.0000000000003269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/24/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE The aims of this study were to examine the trends in the initial management of herpes zoster ophthalmicus (HZO) in the United States from 2010 to 2018 and compare them with the treatment preferences of corneal specialists. METHODS A retrospective, observational deidentified cohort study was conducted on individuals enrolled in the OptumLabs Data Warehouse who had a new diagnosis of HZO from 1/1/2010 to 12/31/2018. An online survey ascertaining HZO management perspectives was distributed to The Cornea Society listserv. The main outcome assessed was proportion of cases with systemic antiviral prescriptions, eye care provider involvement, and follow-up visits after the initial HZO diagnosis. RESULTS Approximately 50% of patients received systemic antivirals the day of initial HZO diagnosis or within 7 days (45.6% and 53.7%, respectively). Most initial diagnoses were made by ophthalmologists (45.0%), followed by optometrists (19.2%). Referral rate to ophthalmology within a year of initial diagnosis was 38.6%. 48.7% cases had at least 1 follow-up visit with any type of provider within 30 days. Our survey of corneal specialists found 97% would prescribe systemic antivirals to those with ocular involvement, but 66% would prescribe antivirals to those without ocular or eyelid involvement. Seventy percent supported all patients having follow-up with an eye care provider within a month. CONCLUSIONS HZO antiviral therapies seem to be underprescribed in the United States, referral rates to ophthalmology are low, and follow-up is suboptimal, which are not aligned with recommendations from corneal specialists. More research is needed to establish standardized guidelines for treatment, referral, and follow-up with ophthalmology for HZO.
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Affiliation(s)
- Angela Lu
- F.I. Proctor Foundation, University of California, San Francisco, California
| | - Yuwei Sun
- F.I. Proctor Foundation, University of California, San Francisco, California
| | - Travis C. Porco
- F.I. Proctor Foundation, University of California, San Francisco, California
- Department of Ophthalmology, University of California, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Benjamin F. Arnold
- F.I. Proctor Foundation, University of California, San Francisco, California
- Department of Ophthalmology, University of California, San Francisco, California
| | - Nisha R. Acharya
- F.I. Proctor Foundation, University of California, San Francisco, California
- Department of Ophthalmology, University of California, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
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Lampen SIR, Quinn MP, Pike D, Rullo J, Ten Hove MW. Thrombophlebitis-Mediated Polycranial Neuropathy Secondary to Herpes Zoster Ophthalmicus. J Neuroophthalmol 2023; 43:e291-e292. [PMID: 34924539 DOI: 10.1097/wno.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Shaun I R Lampen
- Queen's University School of Medicine (SIRL), Kingston, Canada; and Department of Ophthalmology (MPQ, DP, JR, MWH), Queen's University and Kingston Health Sciences Centre, Kingston, Canada
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11
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Pinzon RT, Afifudin M, Karuniawati I. Isolated Abducens Nerve Palsy After Herpes Zoster Ophthalmicus: A Case Report. Rom J Ophthalmol 2023; 67:408-411. [PMID: 38239427 PMCID: PMC10793366 DOI: 10.22336/rjo.2023.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/22/2024] Open
Abstract
Aim: The purpose of this study was to demonstrate a case of herpes zoster in the patient. Methods: Case report. Results: Herpes zoster ophthalmicus is a rare but well-known cause of CN VI palsy that affects an elderly patient due to a reduction in the immunity to the Varicella Zoster Virus (VZV). We reported a case of herpes zoster in our patient, a 67-year-old Javanese female who presented with a VI nerve palsy within 1 week after the vesicular rash. Our patient received Valacyclovir, Gabapentin, and steroid treatment, then responded quite well to the combination of these therapies without side effects as the goals were to diminish acute and chronic pain, fasten the healing of the skin and nerve, and reduce the chances of dissemination. Based on studies, systemic antivirals should be given in all cases of HZO to minimize complications and steroids should not be given without antiviral therapy so as not to increase viral replication. Conclusions: As a complication of HZO, ophthalmoplegia may have various origins. We reported a case of sixth nerve palsy in HZO. Abbreviations: HZO = herpes zoster ophthalmicus, VZV = varicella-zoster virus, CN = Cranial Nerve.
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Affiliation(s)
| | - Marlyna Afifudin
- Duta Wacana Christian University, School of Medicine, Yogyakarta, Indonesia
| | - Isa Karuniawati
- Duta Wacana Christian University, School of Medicine, Yogyakarta, Indonesia
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Comín-Pérez A, Albert-Fort M, Pascual EV, Alegre-Ituarte V, Martínez-Costa L. Atypical herpes zoster ophthalmicus with madarosis of upper eyelid, recurrent iridocyclitis and atrophic multifocal chorioretinopathy. Eur J Ophthalmol 2023; 33:NP41-NP46. [PMID: 36314406 DOI: 10.1177/11206721221136312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Ocular involvement due to varicella-zoster virus (VZV) infection includes conjunctivitis, scleritis, keratitis, uveitis, and necrotizing retinitis. Non-necrotizing chorioretinopathy as a late manifestation has been described. CASE REPORT A 50-year-old immunocompetent man developed herpes zoster ophthalmicus (HZO) in the right V1 dermatome with acute anterior uveitis (AAU) treated with oral valaciclovir and topical steroid and a chalazion in the upper eyelid with associated madarosis. Four months later, he presented recurrence of the AAU and multiple areas of chorioretinal atrophy on fundoscopy. Biopsy of the upper eyelid lesion revealed granulomatous inflammation of the eyelid margin and polymerase chain reaction study (PCR) tested positive for VZV-specific DNA. The iridocyclitis was resolved with oral valaciclovir at maximum doses with minimal choroidal pigmentary changes. DISCUSSION VZV ophthalmic infection starts by reactivation from the trigeminal ganglion, and it spreads to the isthmus of the pilosebaceous follicles and the epidermis, which can cause involvement of follicle and sebaceous glands. Chorioretinopathy is a rare form of late-onset non-necrotizing herpetic uveitis characterized by atrophic-appearing hypopigmented lesions, the pathogenesis of which is unknown. A direct viral infection or secondary to occlusive choroidal vasculitis is postulated at the level of the choriocapillaris and more recently it has been referred to as "choroidal vitiligo" due to possible involvement of choroidal melanocytes, as occurs in cases of cutaneous vitiligo due to VZV infection.
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Affiliation(s)
- Alberto Comín-Pérez
- Department of Ophthalmology, Doctor Peset University Hospital, Valencia, Spain
| | - Mara Albert-Fort
- Department of Ophthalmology, Doctor Peset University Hospital, Valencia, Spain
| | - Elia Valls Pascual
- Department oh Rheumatology, Doctor Peset University Hospital, Valencia, Spain
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Pietrzak MK, Pluta M, Pokorska-Śpiewak M, Marczyńska M. Meningitis in the Course of Herpes Zoster Ophthalmicus in an Immunocompetent Boy. Pediatr Infect Dis J 2023; 42:e361-e362. [PMID: 37235763 DOI: 10.1097/inf.0000000000003985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Maja K Pietrzak
- Pediatric Infectious Diseases Department, Regional Hospital of Infectious Diseases, Warsaw, Poland
| | - Magdalena Pluta
- Pediatric Infectious Diseases Department, Regional Hospital of Infectious Diseases, Warsaw, Poland
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Maria Pokorska-Śpiewak
- Pediatric Infectious Diseases Department, Regional Hospital of Infectious Diseases, Warsaw, Poland
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Marczyńska
- Pediatric Infectious Diseases Department, Regional Hospital of Infectious Diseases, Warsaw, Poland
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
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Rand K, He K, Dien Bard J, Braskett M, Mohandas S. The Brief Case: Vaccine strain herpes zoster ophthalmicus and meningoencephalitis in an immunocompetent child. J Clin Microbiol 2023; 61:e0071422. [PMID: 37611239 PMCID: PMC10446867 DOI: 10.1128/jcm.00714-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Affiliation(s)
- Katherine Rand
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Kaidi He
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Division of Infectious Disease, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Melinda Braskett
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Division of Clinical Immunology and Allergy, Childrens Hospital Los Angeles, Los Angeles, California, USA
| | - Sindhu Mohandas
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Division of Infectious Disease, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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15
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Cohen S, Olshaker H, Fischer N, Vishnevskia-Dai V, Hagin D, Rosenblatt A, Zur D, Habot-Wilner Z. Herpetic Eye Disease Following the SARS-CoV-2 Vaccinations. Ocul Immunol Inflamm 2023; 31:1151-1162. [PMID: 35914308 DOI: 10.1080/09273948.2022.2103831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/16/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To describe herpetic ocular infections following SARS-CoV-2 vaccinations. METHODS A retrospective study of herpetic ocular infections after BNT162b2mRNA vaccination and a literature review. RESULTS A cohort of five patients: three varicella zoster virus (VZV) and two herpes simplex virus (HSV) cases, as well as 19 literature cases: 9 cases of VZV and 10 cases of HSV post BNT162b2mRNA, AZD1222, mRNA-1273, and CoronaVac vaccinations. All cases presented within 28 days post vaccination. Most VZV and HSV cases (15/19) reported in the literature presented post first vaccine dose, while in our cohort 2 VZV cases presented post second dose and both HSV cases and one VZV case post third dose. The most common presentations were HZO with ocular involvement and HSV keratitis. All eyes had complete resolution; however, one had retinal detachment and three corneal scars. CONCLUSION Herpetic ocular infections may develop shortly after SARS-CoV-2 vaccinations. Overall, the outcome is good.
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Affiliation(s)
- Shai Cohen
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagar Olshaker
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Fischer
- Department of Ophthalmology, Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vicktoria Vishnevskia-Dai
- Goldschleger Eye Institute, Department of Ophthalmology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Hagin
- Allergy and Clinical Immunology Unit, Department of Medicine, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Rosenblatt
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar Habot-Wilner
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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de Paiva JLR, Cardoso TAMDO, Reis F. Associating herpes zoster ophthalmicus with cerebral vasculitis. Rev Soc Bras Med Trop 2023; 56:e01552023. [PMID: 37493743 PMCID: PMC10367217 DOI: 10.1590/0037-8682-0155-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/19/2023] [Indexed: 07/27/2023] Open
Affiliation(s)
- Jean Levi Ribeiro de Paiva
- Universidade Estadual de Campinas, Departamento de Anestesiologia, Oncologia e Radiologia, Campinas, SP, Brasil.Universidade Estadual de CampinasDepartamento de Anestesiologia, Oncologia e RadiologiaCampinasSPBrasil
| | | | - Fabiano Reis
- Universidade Estadual de Campinas, Departamento de Anestesiologia, Oncologia e Radiologia, Campinas, SP, Brasil.Universidade Estadual de CampinasDepartamento de Anestesiologia, Oncologia e RadiologiaCampinasSPBrasil
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17
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Ashikawa Y, Kusunoki Nakamoto F, Sato T, Katsumata J, Bannai T, Seki T, Takeda M, Shiio Y. Successful Treatment of Herpes Zoster Ophthalmicus Complicated by Intense Orbital Inflammation Using Laser Irradiation over the Stellate Ganglion. Intern Med 2023; 62:623-627. [PMID: 35831112 PMCID: PMC10017239 DOI: 10.2169/internalmedicine.9503-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 56-year-old man presented with right-sided headache and ptosis accompanied by a facial skin rash. He was diagnosed with herpes zoster ophthalmicus (HZO). Despite acyclovir and steroid therapy, the ocular symptoms worsened. Magnetic resonance imaging (MRI) revealed severe orbital inflammation and abnormal lesions in the right trigeminal nucleus and tract. The effects of re-administration of intravenous acyclovir and steroid pulse therapy were limited. Laser irradiation of the stellate ganglion (SGL) and high-dose oral prednisolone therapy were effective. Our experience suggests the efficacy of early multimodal treatment, including SGL, in treating ocular symptoms associated with HZO.
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Affiliation(s)
| | | | - Tatsuya Sato
- Department of Neurology, Tokyo Teishin Hospital, Japan
| | | | - Taro Bannai
- Department of Neurology, Tokyo Teishin Hospital, Japan
| | - Tomonari Seki
- Department of Neurology, Tokyo Teishin Hospital, Japan
| | - Masako Takeda
- Department of Anesthesiology, Tokyo Teishin Hospital, Japan
| | - Yasushi Shiio
- Department of Neurology, Tokyo Teishin Hospital, Japan
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18
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Kingrey BS, Cretara EA, Chen WS. A Case of Orbital Apex Syndrome as a Complication of Herpes Zoster Ophthalmicus. R I Med J (2013) 2022; 105:49-51. [PMID: 36413452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We present a case of herpes zoster ophthalmicus (HZO) with a rare complication of orbital apex syndrome (OAS) manifesting as optic perineuritis with multiple cranial nerve palsies. A 65-year-old with COPD presented to the hospital with a vesicular rash involving his left eyelid. He was admitted for HZO and a concurrent COPD exacerbation. The HZO was treated with antivirals and the COPD exacerbation was treated with corticosteroids. On hospital day three, he developed left-sided ptosis, ophthalmoplegia, and a mid-dilated fixed pupil. MRI of the brain demonstrated enhancement of the left optic nerve sheath, rectus muscles, and periorbital soft tissues. He was diagnosed with OAS and treated with an increased dose of corticosteroids. After two months, his orbital symptoms resolved. This case is unique because the patient developed HZO in the setting of corticosteroid treatment for a COPD exacerbation, and his HZO progressed to OAS despite proper initiation of antiviral therapy.
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Affiliation(s)
- Brandon S Kingrey
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elizabeth A Cretara
- Resident 2019, Ophthalmology Division of The Warren Alpert Medical School of Brown University, Providence, Rhode Island; UNM Health Sciences Center, University of New Mexico, Albuquerque, NM
| | - Wendy S Chen
- Ophthalmology Division of The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Amblard MA, Costantini E, Hayek G, Ricaud X. Zona ophtalmique après vaccination par Pfizer BNT162b2 et Moderna mRNA-1273 chez deux patients jeunes et immunocompétents. J Fr Ophtalmol 2022; 45:1000-1003. [PMID: 36155145 PMCID: PMC9499740 DOI: 10.1016/j.jfo.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/01/2022] [Indexed: 11/28/2022]
Abstract
La pandémie de Coronavirus Disease 2019 (COVID-19) a émergé à Wuhan, en Chine. Causée par un virus, le SARS-CoV-2, cette dernière s’est répandue dans le monde en quelques semaines. Parallèlement à la gestion de la crise sanitaire sur le terrain, la communauté scientifique s’est penchée sur un moyen de l’enrayer. Des vaccins candidats à ARNm tels que Pfizer BNT162b2 et Moderna m-RNA-1273 ont donc été développés. Leur récente mise sur le marché soulève cependant des inquiétudes quant à leurs potentiels effets secondaires, parmi eux, le zona ophtalmique.
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Affiliation(s)
- M A Amblard
- Centre ophtalmologique Place de l'Étoile, Luxembourg
| | - E Costantini
- Centre ophtalmologique Place de l'Étoile, Luxembourg; Centre laser Monterey, Luxembourg
| | - G Hayek
- Centre ophtalmologique Place de l'Étoile, Luxembourg
| | - X Ricaud
- Centre ophtalmologique Place de l'Étoile, Luxembourg; Centre laser Monterey, Luxembourg.
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20
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Blanco-Palmero VA, Ortueta-Olartecoechea A, Uriarte-Pérez de Urabayen D, Sánchez-Tornero M, Méndez-Guerrero A, Matarazzo M. Isolated Nonreactive Mydriasis in Herpes Zoster Ophthalmicus: An Uncommon Complication. J Neuroophthalmol 2022; 42:e508-e510. [PMID: 34483333 DOI: 10.1097/wno.0000000000001289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Víctor Antonio Blanco-Palmero
- Hospital Universitario 12 de Octubre (VAB-P, DU-PU, MS-T, AM-G), Neurology Department, Madrid, Spain; Hospital Universitario 12 de Octubre (AO-O), Ophthalmology Department, Madrid, Spain; HM-CINAC (MM), Hospital Universitario HM Puerta del Sur, Neurology Department, Móstoles, Spain; and Pacific Parkinson's Research Centre (MM), University of British Columbia, Vancouver, BC, Canada
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21
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Abstract
There are several reports that herpes zoster characterized by reactivation of varicella zoster virus (VZV) following coronavirus disease 2019 (COVID-19) vaccines can occur. Herein, we report VZV meningitis, herpes zoster ophthalmicus (HZO), and late neurotrophic keratitis after receiving a second dose of messenger RNA (mRNA) COVID-19 vaccine. A 74-year-old man developed a vesicular skin rash on the forehead, scalp, nose, and left upper eyelid with a severe headache. Five days earlier, he received a second dose of the BNT162b2 mRNA vaccine on his left arm. Ocular examination revealed conjunctival hyperemia and pseudodendrite in the peripheral cornea. VZV was detected in the cerebrospinal fluid using polymerase chain reaction. The patient was diagnosed with HZO and meningitis. The patient was treated with intravenous acyclovir and topical acyclovir ointment and levofloxacin 1.5% eye drops. One month later, he developed a central epithelial defect with a rolled margin, typical of a neurotrophic ulcer. Treatment with a therapeutic contact lens and a combination of topical recombinant human epithelial growth factor and ofloxacin ointment was initiated. At six months after vaccination, the slit-lamp examination findings were stable with a mild corneal superficial stromal haze.
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Affiliation(s)
- In-Cheon You
- Department of Ophthalmology, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
| | - Min Ahn
- Department of Ophthalmology, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Nam-Chun Cho
- Department of Ophthalmology, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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22
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Abstract
PURPOSE The purpose of this study was to report a case of acute exacerbation in varicella-zoster virus (VZV) keratitis after SARS-CoV-2 vaccination. METHODS An 87-year-old man, with a history of herpes zoster ophthalmicus 10 years ago, was referred for sudden visual impairment in his left eye that started 2 days after his second dose of SARS-CoV-2 mRNA vaccine BNT162b2. RESULTS At presentation, his visual acuity was hand motion. Slitlamp examination revealed diffuse corneal stromal edema and nasal stromal infiltration. After treatment for 2 weeks with oral valacyclovir and topical corticosteroids, the problematic lesion was recovered and his visual acuity was restored to 20/30. CONCLUSIONS We believe that this is the first report of possible association between recurrence of VZV keratitis and SARS-CoV-2 vaccination. We believe that T-cell activation by the host response after vaccination may affect the recurrence of VZV keratitis. Physicians should be aware of the potential of recurrence of VZV keratitis associated with the SARS-CoV-2 messenger RNA vaccine.
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Affiliation(s)
- Kyung Jae Ryu
- Department of Ophthalmology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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23
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Marco Campos S, Tormo Alcañiz MT, Vilaplana Mora I, Almiñana Almiñana AJ, Angelats Romero CM. [Herpes Zoster Ophthalmicus presenting as acute headache]. Andes Pediatr 2022; 93:270-275. [PMID: 35735308 DOI: 10.32641/andespediatr.v93i2.3678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 10/21/2021] [Indexed: 06/15/2023]
Abstract
UNLABELLED Herpes Zoster (HZ) is rare in childhood and is defined as the reactivation of the latent varicella-zoster virus in patients who have previously been infected with varicella. When the virus affects the ophthal mic nerve it is called herpes zoster ophthalmicus (HZO) and it can produce, among other symptoms, acute headache, so it must be considered as a differential diagnosis. OBJECTIVE To describe a clinical case of HZO in a pediatric patient and to recognize its clinical manifestations and their importance in the differential diagnosis of acute headache in children. CLINICAL CASE Immunocompetent 11-year- old girl, vaccinated according to the recommended immunization schedule, excluding chickenpox vaccine due to past infection, presented to the emergency department (ED) with a 5-day long uni lateral headache. After 36 hours of hospitalization, she presented vesicular cutaneous lesions in her forehead, left upper eyelid, and nose. Positive fluorescein stain dendritic corneal lesions were iden tified in the ophthalmic exam. Antiviral systemic and topic therapy were set, obtaining an initial good response, but later she presented complications such as postherpetic neuralgia one month after hospital discharge and several postherpetic neuralgia episodes despite treatment with gabapentin in addition to two herpes zoster ophthalmicus relapses with acute keratouveitis one year after the initial episode. CONCLUSION It is essential to include HZO in the differential diagnosis of acute headache, especially when presented unilaterally and/or with ocular symptoms, regardless of the presence of cutaneous lesions, and even more so in patients with history of chickenpox infection. Those patients who were vaccinated against this disease in their childhood will benefit from at least partial protection against HZO.
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24
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Rehman O, Arya SK, Jha UP, Nayyar S, Goel I. Herpes Zoster Ophthalmicus After COVID-19 Vaccination: Chance Occurrence or More? Cornea 2022; 41:254-256. [PMID: 34690265 DOI: 10.1097/ico.0000000000002881] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/08/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT As the understanding of COVID-19 infection becomes better, it is being recognized as a complex multisystem pathology rather than just affecting the lungs. Several ocular findings have been documented by researchers in individuals infected with COVID-19, and ocular symptoms may even be the first presenting feature of COVID-19 infection in 2.26% individuals. Several countries have started vaccination with inactivated or live vaccines to combat this pandemic, and varied side effects have been reported after vaccination. Few cases of herpes zoster have previously been reported in elderly patients with comorbidities after receiving COVID-19 vaccines. In this article, the authors described 2 interesting cases of herpes zoster ophthalmicus (HZO) after receiving a live COVID-19 vaccine. The first case was a 35-year-old immunocompetent man who developed HZO 3 days postvaccine. The second case was a 40-year-old immunocompetent man who developed HZO 28 days postvaccine. To the best of our knowledge, no literature to date has described HZO after live vaccine.
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Affiliation(s)
- Obaidur Rehman
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
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25
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Ayisi-Boateng E, Ayisi-Boateng NK, Amoah K, Wiafe B. Orbital Apex Syndrome: a rare complication of herpes zoster ophthalmicus in a Ghanaian woman living with HIV. Ghana Med J 2021; 55:315-318. [PMID: 35957932 PMCID: PMC9334965 DOI: 10.4314/gmj.v55i4.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Herpes Zoster Ophthalmicus (HZO) usually affects the immunocompromised and aged. It results from the reactivation of latent varicella zoster infection in the trigeminal ganglia. Orbital apex syndrome (OAS) is a rare sequela of the disease and tends to be disfiguring and vision-threatening if not addressed. We report on a 43-year-old Ghanaian female living with Human Immunodeficiency Virus infection and on highly active antiretroviral therapy who presented with a 2-month history of a healed vesicular rash left side of the forehead and a droopy left upper eyelid. On examination, she had complete ptosis, visual acuity in the left eye was 6/36, and restricted mobility in all directions of gaze. On anterior segment examination using a slit lamp biomicroscope, the left eye had mild cornea oedema with keratic precipitates and relative afferent pupillary defect (RAPD). Intraocular pressure and posterior segment of the right eye were normal. Computed tomography (CT) Scan of the head was taken to rule out other causes of OAS. Patient was treated with oral acyclovir 400mg five times daily for 30 days, topical steroids and oral prednisolone 60mg daily for 30 days which was tapered. Ptosis improved significantly with mild supraduction and infraduction deficit. Visual acuity improved to 6/12 and all keratic precipitates cleared. The patient, however, developed a corneal scar from a possible neurotrophic ulcer after defaulting treatment for 11 months. OAS , as a rare sequalae of HZO, responds well to oral acyclovir and steroids. Prompt diagnosis and appropriate treatment, even at late presentation, yield positive outcomes.
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Affiliation(s)
| | - Nana K Ayisi-Boateng
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Infectious Disease Unit, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwadwo Amoah
- Eye Clinic, Kumasi South Hospital, Kumasi, Ghana
| | - Boateng Wiafe
- Operation Eyesight Universal, Accra, Ghana
- Watborg Eye Services, Kasoa, Ghana
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Affiliation(s)
- Marlene L Durand
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts
| | - Miriam Baron Barshak
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts
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27
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Niederer RL, Meyer JJ, Liu K, Danesh-Meyer HV. Herpes Zoster Ophthalmicus Clinical Presentation and Risk Factors for Loss of Vision. Am J Ophthalmol 2021; 226:83-89. [PMID: 33571476 DOI: 10.1016/j.ajo.2021.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the rate of moderate and severe vision loss following herpes zoster ophthalmicus (HZO) and to identify associated factors. DESIGN Retrospective cohort study. METHODS All subjects with acute HZO seen at a single center from 2006 to 2016 were included in the study. The primary outcome measure was the proportion of individuals with moderate and/or severe loss of vision following an acute episode of HZO. Secondary outcome measures included causes and factors associated with permanent loss of vision owing to HZO. RESULTS A total of 869 patients with acute HZO were identified with a median follow-up time of 6.3 years (interquartile range 3.7-8.9 years). Ocular involvement of HZO was diagnosed at or within the first month of presentation in 737 individuals (84.8%). The most common sites of ocular involvement were conjunctivitis (76.1%), followed by keratitis (51.2%) and uveitis (47.6%). Moderate vision loss (≤20/50) secondary to HZO occurred in 83 eyes (9.6%) while severe vision loss (≤20/200) occurred in 31 eyes (3.6%). Causes of loss of vision included corneal scarring (94.0%), corneal perforation (4.8%), and secondary glaucoma (1.2%). Severe vision loss was associated with older age (hazard ratio [HR] 1.059, P = .001), immunosuppression (HR 3.125, P = .028), poor presenting visual acuity (HR 2.821, P = .002), and uveitis (HR 4.777, P = .004) on multivariate analysis. CONCLUSIONS Among individuals with HZO, approximately 1 in 10 individuals may develop moderate or severe vision loss, primarily owing to corneal scarring. Older age, immunosuppression, and uveitis are associated with severe permanent loss of vision secondary to HZO.
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Affiliation(s)
- Rachel Louise Niederer
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand; and Department of Ophthalmology, University of Auckland, Auckland, New Zealand.
| | - Jay J Meyer
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand; and Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Kevin Liu
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand; and Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand; and Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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28
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Abstract
PURPOSE To report a case of Zostavax-associated acute retinal necrosis in a patient with chronic lymphocytic leukemia. METHODS Case report. PATIENTS A 76-year-old white man. RESULTS Unilateral acute retinal necrosis with obliterative angiopathy developed in close proximity of a Zostavax vaccine. Treatment with valacyclovir hydrochloride (1 g orally three times a day) and intravitreal ganciclovir (4 mg/0.1 mL) was initiated on presentation. Because of continuous increase of the retinal necrosis, patient was switched to intravenous acyclovir (7.5 mg/kg body weight, adapted to reduced glomerular filtration rate) and given intravitreal foscarnet (2.4 mg/0.1 mL). Despite being on maximal antiviral therapy, the patient suffered a central retinal artery occlusion. DISCUSSION Acute retinal necrosis is a severe complication and potentially blinding disease of herpes zoster, and can occur in association with herpes zoster immunization, in particular, in immune suppressed patients.
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Affiliation(s)
- Moreno Menghini
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Hospital Ave, Western Australia, Australia
| | - Vignesh Raja
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Hospital Ave, Western Australia, Australia
| | - Jeremy Raiter
- Private Ophthalmology Practice, Karrinyup, Washington, Australia ; and
| | - Chandrakumar Balaratnasingam
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Hospital Ave, Western Australia, Australia
- Lions Eye Institute, Perth, Washington, Australia
| | - Ian J Constable
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Hospital Ave, Western Australia, Australia
- Lions Eye Institute, Perth, Washington, Australia
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29
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Chakrabarti R, George G, Wells K, Crock C, Fahy E. Characteristics, treatment and complications of herpes zoster ophthalmicus at a tertiary eye hospital. Med J Aust 2020; 213:226-227. [PMID: 32200560 DOI: 10.5694/mja2.50554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/25/2019] [Indexed: 02/08/2024]
Affiliation(s)
| | - Grace George
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Kristen Wells
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC
| | - Carmel Crock
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC
| | - Eamonn Fahy
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC
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30
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Ez-Zahraoui M, El Moize Z, Ben Dali I, Saoudi Hassani S, Cherkaoui O. [Zoster ophthalmicus in an infant: A case report]. J Fr Ophtalmol 2019; 42:671-672. [PMID: 31130392 DOI: 10.1016/j.jfo.2018.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/13/2018] [Indexed: 11/18/2022]
Affiliation(s)
- M Ez-Zahraoui
- Service d'ophtalmologie A, CHU Ibn Sina, Souissi, BP 6220 Rabat, Maroc.
| | - Z El Moize
- Service d'ophtalmologie A, CHU Ibn Sina, Souissi, BP 6220 Rabat, Maroc
| | - I Ben Dali
- Service d'ophtalmologie A, CHU Ibn Sina, Souissi, BP 6220 Rabat, Maroc
| | - S Saoudi Hassani
- Service d'ophtalmologie A, CHU Ibn Sina, Souissi, BP 6220 Rabat, Maroc
| | - O Cherkaoui
- Service d'ophtalmologie A, CHU Ibn Sina, Souissi, BP 6220 Rabat, Maroc
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Affiliation(s)
- Darren Shu Jeng Ting
- Sunderland Eye Infirmary, Sunderland, UK
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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Galassi G, Genovese M, Meacci M, Malagoli M. Varicella zoster virus reactivation antedating ipsilateral brainstem stroke. Dermatol Online J 2018; 24:13030/qt4gj9h9jf. [PMID: 30677856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023] Open
Abstract
itor Title: Varicella zoster virus reactivation antedating ipsilateral brainstem stroke Authors: Giuliana Galassi1, Maurilio Genovese2, Marisa Meacci3, Marcella Malagoli2 Affiliations: 1Department of Biomedical, Metabolic, Neural Sciences, University Hospital of Modena, Italy, 2Neuroradiology Service, University Hospital of Modena, Italy, 3Department of Laboratory Medicine and Patholgy, Microbiology and Virology Unit, University Hospital of Modena, Italy Corresponding Author: Giuliana Galassi, MD, Department of Biomedical, Metabolic, Neural Sciences, University Hospital of Modena, Via P. Giardini 1455, Modena, Italy, Tel: 39-3497325802, Email: giulianagalassi46@gmail.com Abstract: Varicella zoster virus (VZV) infection and reactivation are associated with a number of neurologic conditions. Unifocal large vessel infarcts may follow zoster in the trigeminal or cervical distribution as a result of transaxonal transport of virus from trigeminal or cervical afferent fibers that innervate vessels. Ophthalmic zoster (HZO) might cause ophthalmoplegic syndromes, with secondary optic neuritis. Mechanisms include local orbital muscle inflammation and, viral spread from the ophthalmic branch of the fifth nerve with associated vasculopathy. A 72-year-old man developed a vesicular rash in the territory of C5-T5-6. Within four weeks, the patient developed headache, dysphagia, left facial and extremity ataxic weakness. Magnetic resonance imaging (MRI) revealed a right pontine infarction. A 66-year-old woman presented with right-sided painfull HZO. One week later she developed complete external ophthalmoplegia and blurred vision. MRI showed ill-defined signal alteration in the retrobulbar tissue. Three weeks later, the patient was admitted because of dysarthria, deviated tongue, left-sided limb weakness, and tactile hypoesthesia. Spinal fluid contained 23 lymphocytes/mm3 and increased protein. The serum contained antibodies to VZV IgG and IgM in both cases. The patients received intravenously acyclovir with improvement. This report confirms unusual occurrence of ipsilateral brainstem stroke after VZV reactivation in immunocompetent subjects.
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Affiliation(s)
- Giuliana Galassi
- Department of Biomedical, Metabolic, Neural Sciences, University Hospital of Modena
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Maderuelo Riesco I, Tarrazo Tarrazo C, Martínez García P. [Herpes zoster ophthalmicus in an immunosuppressed patient]. Aten Primaria 2018; 51:191-192. [PMID: 30097178 PMCID: PMC6837117 DOI: 10.1016/j.aprim.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/23/2018] [Accepted: 06/11/2018] [Indexed: 12/05/2022] Open
Affiliation(s)
- Irene Maderuelo Riesco
- Servicio de Medicina Interna, Hospital Universitario San Agustín, Avilés, Asturias, España.
| | - Carlos Tarrazo Tarrazo
- Servicio de Medicina Interna, Hospital Universitario San Agustín, Avilés, Asturias, España
| | - Paula Martínez García
- Servicio de Medicina Interna, Hospital Universitario San Agustín, Avilés, Asturias, España
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Abstract
A 14-year-old girl developed transient disturbance of consciousness, dysarthria, and clumsiness of the right upper limb 4 months after herpes zoster ophthalmicus. Brain MRI showed acute cerebral infarction in the left middle cerebral artery (MCA) territory. CT angiography demonstrated mild stenosis in the top of the left internal carotid artery and the proximal side of the MCA. Cerebrospinal fluid (CSF) examination showed slightly mononuclear pleocytosis (6/μl). Titer of the anti-varicella zoster virus (VZV) IgG antibodies in CSF was increased, and gadolinium-enhanced brain MRI (T1-weighted imaging) revealed enhancement of the vessel walls at the stenotic lesions. Based on the diagnosis of VZV vasculopathy, methylprednisolone and valacicrovir were administered, followed by acyclovir, in addition to antithrombotic therapy using aspirin and warfarin. After these treatment, her right upper clumsiness was resolved and gadolinium-enhancement of the vessel walls was disappeared on MRI. VZV vasculopathy may cause ischemic stroke in young patients, especially in children. A careful history-taking about herpes is necessary to detect the disease as a potential cause in young stroke patients.
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Affiliation(s)
| | - Seigo Shindo
- Department of Neurology, Kumamoto Red Cross Hospital
| | - Kuniyasu Wada
- Department of Neurology, Kumamoto Red Cross Hospital
| | | | - Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
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Zhang Y, Luo G, Huang Y, Yu Q, Wang L, Li K. Risk of Stroke/Transient Ischemic Attack or Myocardial Infarction with Herpes Zoster: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2017; 26:1807-1816. [PMID: 28501259 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/01/2017] [Accepted: 04/09/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Accumulating evidence indicates that herpes zoster (HZ) may increase the risk of stroke/transient ischemic attack (TIA) or myocardial infarction (MI), but the results are inconsistent. We aim to explore the relationship between HZ and risk of stroke/TIA or MI and between herpes zoster ophthalmicus (HZO) and stroke. METHODS We estimated the relative risk (RR) and 95% confidence intervals (CIs) with the meta-analysis. Cochran's Q test and Higgins I2 statistic were used to check for heterogeneity. RESULTS HZ infection was significantly associated with increased risk of stroke/TIA (RR = 1.30, 95% CI: 1.17-1.46) or MI (RR = 1.18, 95% CI: 1.07-1.30). The risk of stroke after HZO was 1.91 (95% CI 1.32-2.76), higher than that after HZ. Subgroup analyses revealed increased risk of ischemic stroke after HZ infection but not hemorrhagic stroke. The risk of stroke was increased more at 1 month after HZ infection than at 1-3 months, with a gradual reduced risk with time. The risk of stroke after HZ infection was greater with age less than 40 years than 40-59 years and more than 60 years. Risk of stroke with HZ infection was greater without treatment than with treatment and was greater in Asia than Europe and America but did not differ by sex. CONCLUSIONS Our study indicated that HZ infection was associated with increased risk of stroke/TIA or MI, and HZO infection was the most marked risk factor for stroke. Further studies are needed to explore whether zoster vaccination could reduce the risk of stoke/TIA or MI.
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Affiliation(s)
- Yanting Zhang
- Department of Public Health, Shantou University Medical College, Shantou, Guangdong, China
| | - Ganfeng Luo
- Department of Public Health, Shantou University Medical College, Shantou, Guangdong, China
| | - Yuanwei Huang
- Department of Public Health, Shantou University Medical College, Shantou, Guangdong, China
| | - Qiuyan Yu
- National Center of STD/AIDS Control and Prevention, China CDC, Changping District, Beijing, China
| | - Li Wang
- Department of Public Health, Shantou University Medical College, Shantou, Guangdong, China
| | - Ke Li
- Department of Public Health, Shantou University Medical College, Shantou, Guangdong, China.
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Abstract
A 66-year-old man presented with headache and ophthalmalgia. Diplopia developed, and he was hospitalized. The left eye had abducent paralysis and proptosis. We diagnosed him with Tolosa-Hunt syndrome and administered methylprednisolone at 1 g/day for 3 days. However, the patient did not respond to treatment. No abnormality was found on his MRI or cerebrospinal fluid examination. Tests showed his serum immunoglobulin G4 and antineutrophil cytoplasmic antibody titers were within normal limits. He also had untreated diabetes mellitus (HbA1c 9.2). One week after first presenting with symptoms, herpes zoster appeared on the patient's dorsum nasi, followed by keratitis and a corneal ulcer. Herpes zoster ophthalmicus with ophthalmoplegia was diagnosed. We began treatment with acyclovir (15 mg/kg) and prednisolone (1 mg/kg, decreased gradually). Ophthalmalgia and the eruption improved immediately. The eye movement disorder improved gradually over several months. It is rare that diplopia appears prior to cingulate eruption of herpes zoster ophthalmicus. We speculated that onset of the eruption was inhibited by strong steroid therapy and untreated diabetes mellitus.
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Affiliation(s)
- Tomohiro Ota
- Department of Neurological Science, Chiba Hokusoh Hospital, Nippon Medical School
| | - Mineo Yamazaki
- Department of Neurological Science, Chiba Hokusoh Hospital, Nippon Medical School
| | - Yusuke Toda
- Department of Neurological Science, Chiba Hokusoh Hospital, Nippon Medical School
| | - Akiko Ozawa
- Department of Neurological Science, Chiba Hokusoh Hospital, Nippon Medical School
| | - Kazumi Kimura
- Department of Neurological Science, Nippon Medical School Hospital
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37
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Schuster AK, Harder BC, Schlichtenbrede FC, Jarczok MN, Tesarz J. Valacyclovir versus acyclovir for the treatment of herpes zoster ophthalmicus in immunocompetent patients. Cochrane Database Syst Rev 2016; 11:CD011503. [PMID: 27841441 PMCID: PMC6464932 DOI: 10.1002/14651858.cd011503.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Herpes zoster ophthalmicus affects the eye and vision, and is caused by the reactivation of the varicella zoster virus in the distribution of the first division of the trigeminal nerve. An aggressive management of acute herpes zoster ophthalmicus with systemic antiviral medication is generally recommended as the standard first-line treatment for herpes zoster ophthalmicus infections. Both acyclovir and its prodrug valacyclovir are medications that are approved for the systemic treatment of herpes zoster. Although it is known that valacyclovir has an improved bioavailability and steadier plasma concentration, it is currently unclear as to whether this leads to better treatment results and less ocular complications. OBJECTIVES To assess the effects of valacyclovir versus acyclovir for the systemic antiviral treatment of herpes zoster ophthalmicus in immunocompetent patients. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2016, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2016), Embase (January 1980 to June 2016), Web of Science Conference Proceedings Citation Index-Science (CPCI-S; January 1990 to June 2016), BIOSIS Previews (January 1969 to June 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP; www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 June 2016. SELECTION CRITERIA We considered all randomised controlled trials (RCTs) in which systemic valacyclovir was compared to systemic acyclovir medication for treatment of herpes zoster ophthalmicus. There were no language restrictions. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, evaluated the risk of bias in included trials, and extracted and analysed data. We did not conduct a meta-analysis, as only one study was included. We assessed the certainty of the evidence for the selected outcomes using the GRADE approach. MAIN RESULTS One study fulfilled the inclusion criteria. In this multicentre, randomised double-masked study carried out in France, 110 immunocompetent people with herpes zoster ophthalmicus, diagnosed within 72 hours of skin eruption, were treated, with 56 participants allocated to the valacyclovir group and 54 to the acyclovir group. The study was poorly reported and we judged it to be unclear risk of bias for most domains.Persistent ocular lesions after 6 months were observed in 2/56 people in the valacyclovir group compared with 1/54 people in the acyclovir group (risk ratio (RR) 1.93 (95% CI 0.18 to 20.65); very low certainty evidence. Dendritic ulcer appeared in 3/56 patients treated with valacyclovir, while 1/54 suffered in the acyclovir group (RR 2.89; 95% confidence interval (CI) 0.31 to 26.96); very low certainty evidence), uveitis in 7/56 people in the valacyclovir group compared with 9/54 in the acyclovir group (RR 0.96; 95% CI 0.36 to 2.57); very low certainty evidence). Similarly, there was uncertainty as to the comparative effects of these two treatments on post-herpetic pain, and side effects (vomiting, eyelid or facial edema, disseminated zoster). Due to concerns about imprecision (small number of events and large confidence intervals) and study limitations, the certainty of evidence using the GRADE approach was rated as low to very low for the use of valacyclovir compared to acyclovir. AUTHORS' CONCLUSIONS This review included data from only one study, which had methodological limitations. As such, our results indicated uncertainty of the relative benefits and harms of valacyclovir over acyclovir in herpes zoster ophthalmicus, despite its widespread use for this condition. Further well-designed and adequately powered trials are needed. These trials should include outcomes important to patients, including compliance.
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Affiliation(s)
- Alexander K Schuster
- University Medical Center MainzDepartment of OphthalmologyLangenbeckstr. 1MainzGermany55131
| | - Björn C Harder
- Medical Faculty Mannheim, Heidelberg UniversityDepartment of OphthalmologyTheodor‐Kutzer‐Ufer 1‐3MannheimGermany68167
| | - Frank C Schlichtenbrede
- Medical Faculty Mannheim, Heidelberg UniversityDepartment of OphthalmologyTheodor‐Kutzer‐Ufer 1‐3MannheimGermany68167
| | - Marc N Jarczok
- Heidelberg UniversityBuilding 4041, 3. OG, Room 306HeidelbergGermany69115
| | - Jonas Tesarz
- Heidelberg UniversityDepartment of General Internal Medicine and Psychosomatics, Medical HospitalIm Neuenheimer Feld 410HeidelbergGermany69120
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Peterson N, Goodman S, Peterson M, Peterson W. Herpes zoster in children. Cutis 2016; 98:93-95. [PMID: 27622252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Herpes zoster (HZ) in immunocompetent children is quite uncommon. Initial exposure to the varicella-zoster virus (VZV) may be from a wild-type or vaccine-related strain. Either strain may cause a latent infection and subsequent eruption of HZ. We present a case of HZ in a 15-month-old boy after receiving the varicella vaccination at 12 months of age. A review of the literature regarding the incidence, clinical characteristics, and diagnosis of HZ in children also is provided.
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Nagel MA, Burns TM, Gilden D. SUNCT headaches after ipsilateral ophthalmic-distribution zoster. J Neurol Sci 2016; 366:207-208. [PMID: 27288808 DOI: 10.1016/j.jns.2016.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/11/2016] [Accepted: 05/13/2016] [Indexed: 11/17/2022]
Abstract
Nine days after left ophthalmic-distribution zoster, a 47-year-old man developed SUNCT headaches (short-lasting unilateral neuralgiform headache with conjunctival injection and tearing). In contrast to two prior cases of SUNCT that developed after varicella zoster virus (VZV) meningoencephalitis without rash, this case describes an association of SUNCT with overt zoster, thus adding to the spectrum of headache and facial pain syndromes caused by VZV reactivation.
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Affiliation(s)
- Maria A Nagel
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ted M Burns
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Don Gilden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, USA.
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40
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Farhoud M, Thompson JC. Painful rash on face. J Fam Pract 2015; 64:E1-E3. [PMID: 26697544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Mahmoud Farhoud
- Orlando Veterans Affairs Medical Center, FL, USA
- University of Central Florida College of Medicine, Orlando, FL, USA.
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Arenas-Archila E, Alvizu F, Muñoz-Sarmiento D. [Preauricular injection of betamethasone depot and acyclovir for the treatment of acute herpes zoster ophthalmicus]. Arch Soc Esp Oftalmol 2015; 90:195-197. [PMID: 25443191 DOI: 10.1016/j.oftal.2014.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 03/06/2014] [Accepted: 03/18/2014] [Indexed: 06/04/2023]
Abstract
CLINICAL CASES Several treatments have been described for the management of patients with herpes zoster ophthalmicus (HZO). However, the progress of these patients is usually slow, and many of them develop postherpetic neuritis (PHN). In the present paper, three clinical cases are presented, in which a significant symptomatic improvement was obtained by using a preauricular injection of a mixture of betamethasone depot combined with acyclovir. PHN did not develop in any of them. DISCUSSION The preauricular injection of betamethasone depot and acyclovir could be a good alternative for the management of HZO.
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Affiliation(s)
- E Arenas-Archila
- Fundación Santa Fe, Departamento de Oftalmología, Bogotá, Colombia
| | - F Alvizu
- Fundación Santa Fe, Departamento de Oftalmología, Bogotá, Colombia
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Baş B, Özden B, Özdemir M, Yüksel EP. Herpes zoster ophthalmicus reactivation following maxillary sinus lift operation: A case report. Eur J Oral Implantol 2015; 8:177-180. [PMID: 26021228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To present a case of Herpes Zoster Ophtalmicus (HZO), which was reactivated postoperatively after a sinus lift operation. MATERIALS AND METHODS A 39-year-old male was referred to our clinic for implant-supported dental rehabilitation. He had maxillary missing teeth in positions 13, 14, 15 and 16 and a pneumatised right maxillary sinus with a bone height of 2 mm. Lateral sinus lifting and bone block grafting was performed before implant insertion. Twelve days after the sinus lift, the patient complained of pain and itching at the infraorbital area extending to the forehead. Clinical examination revealed no signs of infection or allergy. The patient received consultation from a dermatologist in order to rule out a possible dermatological disorder. Finally he was diagnosed with HZO. RESULTS HZO was managed with systemic acyclovir treatment. Vesicular rashes and ptosis was seen 3 days after the medical treatment. After 1 month no postoperative skin or orbital sequela was seen. Three implants were inserted at the right posterior maxilla 5 months after sinus lift. One-year followup was uneventful. CONCLUSIONS Dermatological diseases should always be kept in mind during the differential diagnosis of orofacial pain. In this case the proximity of the operation site and affected area gave rise to the idea that surgical trauma had a possible role in the reactivation of the virus. However, the process of reactivation is not entirely understood and requires further investigations. Early diagnosis is essential for HZO in order to avoid debilitating complications such as postherpetic neuralgia and blindness.
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Kirkwood BJ. Acute retinal necrosis. Insight 2014; 39:14-16. [PMID: 24707567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
MESH Headings
- 2-Aminopurine/analogs & derivatives
- 2-Aminopurine/therapeutic use
- Antiviral Agents/therapeutic use
- Aqueous Humor/virology
- DNA, Viral/analysis
- Eye Infections, Viral/diagnosis
- Eye Infections, Viral/drug therapy
- Eye Infections, Viral/virology
- Famciclovir
- Female
- Glucocorticoids/therapeutic use
- Herpes Zoster Ophthalmicus/diagnosis
- Herpes Zoster Ophthalmicus/drug therapy
- Herpes Zoster Ophthalmicus/virology
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/isolation & purification
- Humans
- Middle Aged
- Ophthalmic Solutions
- Polymerase Chain Reaction
- Prednisolone/analogs & derivatives
- Prednisolone/therapeutic use
- Retinal Necrosis Syndrome, Acute/diagnosis
- Retinal Necrosis Syndrome, Acute/drug therapy
- Retinal Necrosis Syndrome, Acute/virology
- Uveitis, Anterior
- Vitreous Body/virology
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Benotmane FE, Belhassan S. Zona ophtalmique localisation palpébrale bonne évolution sous valaciclovir. Pan Afr Med J 2014; 17:167. [PMID: 25120880 PMCID: PMC4119449 DOI: 10.11604/pamj.2014.17.167.3887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/17/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Fatim-Ezzohra Benotmane
- Université Mohammed V Souissi, Service d'Ophtalmologie A de l'Hôpital des Spécialités, Centre Hospitalier Universitaire, Rabat, Maroc
| | - Salim Belhassan
- Université Mohammed V Souissi, Service d'Ophtalmologie A de l'Hôpital des Spécialités, Centre Hospitalier Universitaire, Rabat, Maroc
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47
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Stiefelhagen P. [First headache, then swollen eye. A migraine this was not]. MMW Fortschr Med 2012; 154:22. [PMID: 23234111 DOI: 10.1007/s15006-012-1425-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Paraskevas GP, Anagnostou E, Vassilopoulou S, Spengos K. Painful ophthalmoplegia with simultaneous orbital myositis, optic and oculomotor nerve inflammation and trigeminal nucleus involvement in a patient with herpes zoster ophthalmicus. BMJ Case Rep 2012; 2012:bcr2012007063. [PMID: 23109414 PMCID: PMC4543994 DOI: 10.1136/bcr-2012-007063] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Viral infection is a rare cause of painful ophthalmoplegia. We report on a 67-year-old patient who developed painful double vision after a vesicular skin rash on the left forehead. MRI disclosed simultaneous inflammatory lesions in all extraocular muscles, the second and third cranial nerve, as well as pathological signal intensity along the spinal trigeminal tract and nucleus within the medulla oblongata and the pons. Cerebrospinal fluid and serum tests for varicella zoster were positive. The patient was treated effectively with intravenous acyclovir and methylprednisolone. Simultaneous lesions in various neighbouring neural structures may be characteristic for the highly neurotropic behaviour of the herpesviridae and should be considered as a cause of painful ophthalmoplegia that can be depicted by appropriate imaging.
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Yiu G, Young LH. Progressive outer retinal necrosis presenting as cherry red spot. Ocul Immunol Inflamm 2012; 20:384-6. [PMID: 22957726 DOI: 10.3109/09273948.2012.710705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report a case of progressive outer retinal necrosis (PORN) presenting as a cherry red spot. METHODS Case report. RESULTS A 53-year-old woman with recently diagnosed HIV and varicella-zoster virus (VZV) aseptic meningitis developed rapid sequential vision loss in both eyes over 2 months. Her exam showed a "cherry red spot" in both maculae with peripheral atrophy and pigmentary changes, consistent with PORN. Due to her late presentation and the rapid progression of her condition, she quickly developed end-stage vision loss in both eyes. CONCLUSIONS PORN should be considered within the differential diagnosis of a "cherry red spot." Immune-deficient patients with a history of herpetic infection who present with visual loss warrant prompt ophthalmological evaluation.
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50
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Lee HY, Kim MG, Park DC, Park MS, Byun JY, Yeo SG. Zoster sine herpete causing facial palsy. Am J Otolaryngol 2012; 33:565-71. [PMID: 22445107 DOI: 10.1016/j.amjoto.2012.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 02/02/2012] [Accepted: 02/13/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aims of this study were to verify the characteristics of zoster sine herpete (ZSH) causing facial palsy and the effects of different treatments and to confirm the difference from other etiologies. METHODS From March 2010 to March 2011, a prospective study was performed on patients with ZSH with facial palsy. Patients were divided into a steroid-treated group and a steroid-antiviral combination group, and then the effects according to regimen of treatment were prospectively analyzed. Last, the difference between the ZSH group and patients diagnosed with Bell palsy and Ramsay Hunt syndrome in the same study period was confirmed retrospectively. RESULTS Forty-five patients were diagnosed as having ZSH. Significant improvement was not observed in the ZSH group regardless of the treatment regimen during a 3-week period (P < .05). In patients with ZSH with accompanying typical pain, significant continuous improvement after 6 weeks was observed in patients with combination therapy (P < .05). Compared with patients with Bell palsy and Ramsay Hunt syndrome, there was a significant difference in recovery rate between patients with ZSH (accompanying pain) and those with Bell palsy (89.9%) (P < .05). CONCLUSION The initiation of recovery in ZSH started later than that in other peripheral palsies, and slower recovery was shown in patients with ZSH with pain compared with those with Bell palsy. Steroid-antiviral combination therapy was a more effective regimen for treatment compared with steroid-only treatment. To improve the accuracy of ZSH diagnosis, confirming the presence of accompanying typical pain is necessary.
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Affiliation(s)
- Ho Yun Lee
- Department of Otolaryngology, College of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongdaemun-gu, Seoul, Korea
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