Coleman Bret-Ashleigh, Frasier Kelly M, Hash Mary Grace, Tisdale George B
Dermatology, Edward Via College of Osteopathic Medicine, Auburn, USA.
Dermatology, Northwell Health, New Hyde Park, USA.
Cureus. 2024 Sep 7;16(9):e68859. doi: 10.7759/cureus.68859. eCollection 2024 Sep.
This case report details a unique presentation of trigeminal herpes zoster with mucosal involvement in a 72-year-old female undergoing prophylactic valacyclovir treatment for suspected herpes labialis. The patient initially presented for a routine skin examination. Despite the absence of clinical evidence of herpes labialis, she was prescribed prophylactic valacyclovir. Three days later, the patient developed a unilateral rash, gingival darkening, and severe ipsilateral tooth pain. An examination revealed a crusted erythematous rash along the mandibular division of the left trigeminal nerve and a darkening of the gums. Diagnosed with trigeminal herpes zoster, she was treated with valacyclovir and a prednisone taper. A follow-up showed the resolution of the skin and gingival lesions, though herpetic neuralgia persisted. This case underscores the complexity and potential atypical presentations of herpes zoster, even under prophylactic antiviral therapy. It highlights the importance of considering herpes zoster in differential diagnoses, especially in patients presenting with unilateral dermatological and mucosal symptoms.
本病例报告详细介绍了一名72岁女性三叉神经带状疱疹的独特表现，该患者因疑似唇疱疹接受预防性伐昔洛韦治疗，出现了黏膜受累情况。患者最初前来进行常规皮肤检查。尽管没有唇疱疹的临床证据，但仍为她开具了预防性伐昔洛韦。三天后，患者出现单侧皮疹、牙龈变黑和同侧严重牙痛。检查发现沿左侧三叉神经下颌支有结痂性红斑皮疹以及牙龈变黑。诊断为三叉神经带状疱疹后，她接受了伐昔洛韦和逐渐减量的泼尼松治疗。随访显示皮肤和牙龈病变消退，但疱疹后神经痛仍持续存在。本病例强调了带状疱疹的复杂性和潜在的非典型表现，即使在预防性抗病毒治疗的情况下也是如此。它突出了在鉴别诊断中考虑带状疱疹的重要性，特别是对于出现单侧皮肤和黏膜症状的患者。
