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Gazeta Médica

versão impressa ISSN 2183-8135versão On-line ISSN 2184-0628

Gaz Med vol.10 no.4 Queluz dez. 2023  Epub 29-Dez-2023

https://doi.org/10.29315/gm.v1i1.502 

Imagens Médicas

Oral Cavity Herpes Zoster: A Rare Presentation of Shingles

Herpes Zoster da Cavidade Oral: Uma Apresentação Rara de Zona

Joana Gonçalves Luís1 
http://orcid.org/0000-0003-1487-4131

Filipa Cardoso Ramos1 
http://orcid.org/0009-0009-1307-5072

1. USF São Lourenço, ACES Cávado I, Braga, Portugal.


Keywords: Herpes Zoster; Mouth Diseases; Trigeminal Nerve

Palavras-chave: Doenças da Boca; Herpes Zoster; Nervo Trigémio

A healthy 56-year-old male was observed in the Family Health Unit presenting a 48-hour history of burning sensation and pain in the palate associated with dysesthesia and facial tenderness restricted to the skin over the right zygomatic bone. No other symptoms were reported. The physical examination revealed a vesicular eruption on the hard palate, on the right side of the midline, compatible with a possible varicella-zoster virus reactivation (Figs. 1 e 2). The patient had previous history of chickenpox, but not shingles. The clinical diagnosis of second branch trigeminal herpes zoster was established, supported by the painful vesicular eruption and sensitivity disturbances confined to the corresponding dermatome of the right maxillary nerve. The alternative diagnosis of herpes simplex infection was considered, however, due to the characteristic unilateral distribution of the oral lesions and to the associated cutaneous facial symptoms on the same dermatome, herpes zoster was accounted as the most likely diagnosis. The patient was treated empirically with oral valacyclovir for one week, which led to complete symptom resolution. Shingles has a lifetime incidence of around 30%,1 which increases with age, affecting the trigeminal nerve in 20% of cases. (2 The first division of the nerve is most commonly involved, causing ophthalmic herpes zoster, whereas the second and third branch involvement are far less common. (3 Maxillary herpes zoster constitutes a rare presentation, especially without a cutaneous rash, and should include the differential diagnosis of ulcerative lesions of the oral mucosa. (3,4 It can also present by mimicking odontogenic pain. (3,5 Early diagnosis allows rapid treatment initiation, accelerating acute neuritis resolution. (6 Postherpetic neuralgia is the main complication of herpes zoster, defined as a persistent neuropathic pain restricted to the affected dermatome after the resolution of the initial symptoms.1

Figure 1 Vesicular lesions on the hard palate. 

Figure 2 Ampliation of the vesicular lesions on the hard palate. 

References

1. Gershona AA, Gershonb MD, Breuerc J, Levind MJ, Oaklandere AL, Griffithsf PD. Advances in the understanding of the pathogenesis and epidemiology of herpes zoster. J Clin Virol. 2010;48:S2-S7. doi: 10.1016/S1386-6532(10)70002-0. [ Links ]

2. Pelloni LS, Pelloni R, Borradori L. Herpes zoster of the trigeminal nerve with multi-dermatomal involvement: a case report of an unusual presentation. BMC Dermatol. 2020;20:12. doi: 10.1186/s12895-020-00110-1. [ Links ]

3. Paquin R, Susin LF, Welch G, Barnes JB, Stevens MR, Tay FR. Herpes Zoster Involving the Second Division of the Trigeminal Nerve: Case Report and Literature Review. J Endod. 2017;43:1569-73. doi: 10.1016/j.joen.2017.03.004. [ Links ]

4. Santosh AB, Muddana K. Viral infections of oral cavity. J Family Med Prim Care. 2020;9:36-42. doi: 10.4103/jfmpc.jfmpc_807_19. [ Links ]

5. Hagiya H, Nakagami F, Isomura E. Oral shingles. BMJ Case Rep. 2018;11:e228383. doi: 10.1136/bcr-2018-228383. [ Links ]

6. Schmader K. Herpes Zoster. Clin Geriatr Med. 2016; 32:539-53. doi: 10.1016/j.cger.2016.02.011. [ Links ]

Declaração de Contribuição/Contributorship Statement

JL e FR: Escrita, revisão do artigo e aprovação da versão final a ser publicada

JL and FR: Writing, article review and approval of the final version to be published

Responsabilidades Éticas

Conflitos de Interesse: Os autores declaram a inexistência de conflitos de interesse na realização do presente trabalho.

Fontes de Financiamento: Não existiram fontes externas de financiamento para a realização deste artigo.

Confidencialidade dos Dados: Os autores declaram ter seguido os protocolos da sua instituição acerca da publicação dos dados de doentes.

Consentimento: Consentimento do doente para publicação obtido.

Proveniência e Revisão por Pares: Não comissionado; revisão externa por pares.

Ethical Disclosures

Conflicts of Interest: The authors have no conflicts of interest to declare.

Financing Support: This work has not received any contribution, grant or scholarship.

Confidentiality of Data: The authors declare that they have followed the protocols of their work center on the publication of data from patients.

Patient Consent: Consent for publication was obtained.

Provenance and Peer Review: Not commissioned; externally peer reviewed.

Received: September 16, 2021; Accepted: November 27, 2023; preprint: December 15, 2023; Published: December 29, 2023

Autor Correspondente/Corresponding Author: Joana Gonçalves Luís [joanagluis8@gmail.com] ORCID iD: 0000-0003-1487-4131

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License