International Journal of Clinical Case Reports 2017, Vol.7, No.3, 9-14
9
Case Series Open Access
Herpes Zoster Infections (HZIs): Case Series
Nivedita Tayde
1
, Abhishek Singh Nayyar
2
, V. Sreenivasan
1
1 Department of Oral Medicine and Radiology, Saraswati-Dhanwantari Dental College and Hospital and Post-Graduate Research Institute, Parbhani,
Maharashtra, India
2 Department of Oral Medicine and Radiology, Saraswati-Dhanwantari Dental College and Hospital and Post-Graduate Research Institute, Parbhani,
Maharashtra, India
Corresponding author e-mail
International Journal of Clinical Case Reports 2017, Vol.7, No.3 doi
Received: 20 Mar., 2017
Accepted: 24 Apr., 2017
Published: 5 May, 2017
Copyright © 2017
Tayde et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Tayde N., Nayyar A.S., and Sreenivasan V., 2017, Herpes Zoster Infections (HZIs): case series, International Journal of Clinical Case Reports, 7(3): 9-14
(doi
Abstract
Herpes zoster infections (HZIs) or, shingles are painful eruptions, usually unilateral, caused by the re-activation of
varicella zoster virus (VZV) showing dermatomal distribution. The most commonly affected dermatome is thoraco/lumbar
dermatome followed by cervical and trigeminal. The incidence of herpes zoster infections (HZIs) or, shingles increases with age and
with immuno-suppression. This case series brings forth cases with herpes zoster infections affecting the maxillary division of
trigeminal nerve (V2) showing manifestations in the middle third of face and oral cavity in the affected patients and their successful
management with appropriate therapeutic measures taken.
Keywords
Herpes zoster infections (HZIs) or; Shingles; Varicella zoster virus (VZV); Viral infections; Re-activation; Prodrome
Background
Herpes zoster infections (HZIs) or, shingles are painful eruptions, usually unilateral, caused by the re-activation of
varicella zoster virus (VZV) showing dermatomal distribution. Following primary varicella zoster virus (VZV)
infection, VZV remains latent in the sensory nerve ganglion. The re-activation of the virus may take place years to
decades after the primary infection of VZV (Kasahara et al., 2011). Herpes Zoster Infections (HZIs) are more
common in people with reduced cell mediated immunity. This includes primarily the elderly people, patients
undergoing cancer treatments, patients with chronic immuno-suppression, patients on prolonged drug therapies or,
steroids and the ones with HIV and lymphoma etc (Greenberget al., 2003; Wareham et al., 2007; Handa et al.,
2016). The infection commonly presents with prodrome of dermatomal pain that precedes the appearance of the
characteristic unilateral eruptions characterized by the presence of crops of vesicles in the skin and mucosa which
are unilaterally and linearly distributed alongside the distribution of the affected nerve (Schmader et al., 2011).
The most commonly affected dermatomes are the thoraco/lumbar (45%), cervical (23%) and trigeminal (15%)
(Cohrs et al., 2004). Post-herpetic neuralgia (PHN) is the most debilitating complication of VZV infections
(Wadhawan et al., 2015). The pain associated with herpes zoster can be devastating with a serious impact on the
quality of life (QOL) of the affected patients (Schmader et al., 2011). Managing the disease and prevention of
serious complications represents an important burden on both the health care providers and the society leading to
long-term and/or, permanent morbidities in the affected patients. Re-activation of infection is infrequent in
younger people and children (Wadhawan et al., 2015). Herewith, we are reporting cases of herpes zoster infections
(HZIs) involving the maxillary division of trigeminal nerve (V2) showing manifestations in the middle third of
face and oral cavity in the affected patients.
1 Case Series
1.1 Case 1
A 28 years old female patient came with the chief complaint of pain in the upper jaw in left side since two days
and discomfort in taking food (Figure 1a). The patient revealed a history of appearance of 3-4 vesicles two days
back on the hard palate following their rupture to form ulcer which were associated with pain. The pain as
