A 52-year-old woman with a history of metastatic ovarian cancer under active chemotherapy treatment attended the emergency room due to visual loss and skin lesions of 7 days’ evolution.

On examination, a necrotic ulcer was observed that included the nasal tip, the right nasal wing, and the right nasolabial fold. In addition, she presented redness and pain in the ipsilateral eye. The ophthalmological examination revealed corneal opacification with amaurosis of the right eye (Figure 1). Suspecting herpes zoster with ipsilateral nasal and ophthalmic involvement (Hutchinson’s sign), a polymerase chain reaction sample of the Varicella zoster virus was taken from the ulcer, which confirmed the diagnosis and treatment with intravenous acyclovir at a dose of 10 mg/kg/8 hours for 10 days was performed. Despite the resolution of the skin symptoms, the patient did not recover vision in her right eye.

Figure 1 Clinical presentation of the lesions on arrival at the emergency room. Necrotic ulcer located at the tip, right nasal wing, and right nasolabial fold. Corneal redness and opacification in the ipsilateral eye. 

Hutchinson’s sign constitutes involvement of the nasal tip by the Varicella zoster virus, often prior to ocular involvement, and anatomically reflects the involvement of the nasociliary nerve, which is a branch of the ophthalmic division of the trigeminal nerve.

Early diagnosis and antiviral treatment are essential in these cases since therapeutic withdrawal can lead to irreversible loss of vision¹,².