International Journal of Clinical Case Reports 2017, Vol.7, No.3, 9-14
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Figure 2a Immediate intra-oral photograph in patient 2 at the
time of reporting
Figure 2b Intra-oral photograph at 7
th
post-treatment
follow-up visit
Figure 2c Intra-oral photograph revealing complete recovery at 9
th
post-treatment follow-up visit
1.3 Case 3
A 65 years old female patient reported with the chief complaint of pain and swelling in the right upper and middle
third of face along with burning sensation in the oral cavity since five days (Figure 3a). The pain was severe and
throbbing in nature. There was history of multiple small vesicular eruptions on nose, middle third of face and
upper lip on the right side since two days which were painful. The patient, also, presented with extra-oral swelling
in the right upper and middle third of face involving right eye, right ala of nose and upper lip. The eruptions were
limited to right side only. A slight redness involving the right eye was, also, observed. On palpation, the overlying
skin was tender. On intra-oral examination, multiple crops of irregular, small, shallow ulcers arranged in a linear
distribution and associated with an erythematous patch were observed on right side of the hard palate, not crossing
the midline, and extending from the posterior third of hard palate towards the soft palate posteriorly and from the
midline of the palate medially (along the line of mid palatine raphe) to around 1cm away from the interdental
gingiva in relation to teeth #16, 17 (Figure 3b). There was, also, observed slight swelling on right side of the hard
palate. There was no evidence of vesiculation or, ulceration anywhere else extra-or, intra-orally. Based on the
above mentioned cardinal features of unilateral pain and eruptions involving one side of the face and unilateral
intra-oral involvement, a provisional diagnosis of herpes zoster infection (HZI) of right maxillary (V2) division of
trigeminal nerve was considered. The patient was immediately prescribed Acyclovir 800 mg 5 times a day for 7
days and follow-up appointment was scheduled after 5 days (Figure 3c). After 5 days, the patient reported with
complete resolution of the extra-oral lesions while in the next follow-up appointment after 2 days, the patient
reported with almost complete resolution of the intra-oral lesions with minor erythema that was reported to be
asymptomatic (Figure 3d). 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. After 2 more days, the patient
reported with complete resolution of the lesions (Figure 3e).
