International Journal of Clinical Case Reports 2017, Vol.7, No.3, 9-14
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reported by the patient was severe in nature in the upper jaw and was not localized and attended with fever three
days back. Intra-oral examination revealed multiple ulcers in an erythematous background in relation to left side
of the hard palate not crossing midline. Based on the above findings, a provisional diagnosis of herpes zoster
infection (HZI) of left maxillary division of trigeminal nerve (V2) was considered. The patient was prescribed
Acyclovir 800mg 5 times a day for 7 days and kept on follow-up. After 7 days, the patient reported with resolution
of the lesions with minor erythema that was asymptomatic. The patient was prescribed Acyclovir 1% for topical
applications in the affected region till complete resolution of the erythema and to report in case of any symptoms
(Figure 1b). After 4 days, the patient reported with complete resolution of the lesions (Figure 1c).
Figure 1a Immediate intra-oral photograph in patient 1 at the
time of reporting
Figure 1b Intra-oral photograph at 7
th
post-treatment
follow-up visit
Figure 1c Intra-oral photograph revealing complete resolution of the lesions at 11
th
post-treatment follow-up visit
1.2 Case 2
Another 23 years old female patient reported with the chief complaint of ulcers on right side of the palate since
two days (Figure 2a). The patient gave history of pain in right side of the palate since seven days which got
aggravated since last three days. The pain was continuous but not severe and attended with discomfort and pain in
the right eye since three days. There was no history of fever and malaise. There was no evidence of any
vesiculation or, ulceration extra-orally. On intra-oral examination, multiple small ulcers, approximately 8-10 in
number, were observed on the right side of the palate with a unilateral arrangement in linear pattern. The ulcers
were irregular in shape extending anteriorly in the palatal rugae region towards the mid of the hard palate
posteriorly and from the midline of the palate medially extending to the interdental gingiva in relation to teeth #13,
14 and 15 laterally. No such lesions were observed anywhere else in oral cavity. Based on the abovementioned
clinical findings, a provisional diagnosis of herpes zoster infection (HZI) of right maxillary division of trigeminal
nerve (V2) was considered. The patient was prescribed Acyclovir 600 mg 5 times a day for 7 days and kept on
follow-up. The patient was, then, prescribed Acyclovir 1% for topical applications in the affected region till
complete resolution of the erythema (Figure 2b). After 2 days, the patient reported with complete recovery (Figure
2c).
