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2023

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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EYE PAIN AND EDEMA…AND ZOSTER APPEARED LATER

Elena Finelli1, Margarida Alcafache2, Rita Machado2, Ana Isabel Cordeiro2, António Figueiredo2

1 - Immunoallergology Department, Dona Estefânia Hospital, Lisbon, Portugal;
2 - Pediatric Infectious Diseases Unit, Dona Estefânia Hospital, Lisbon, Portugal.

31st Annual Meeting of the European Society for Paediatric Infecious Diseases
Milão, 28 Maio-1 Junho de 2013. (Poster)

Background: Herpes-Zoster Ophthalmicus (HZO) can result from reactivation of endogenous latent Varicella-zoster virus (VZV) in the sensory ganglia towards the ophthalmic division of the trigeminal cranial nerve. At first, eye pain can be the only symptom. Although rarely reported in childhood, this condition might be sight-threatening.

Aim: The main purpose of our report is to emphasize the possibility of atypical presentation in the reactivation of VZV in the ophthalmic division of the trigeminal nerve, and the importance of early diagnosis to avoid ophthalmic complications.

Case report: Five-year-old girl, previously healthy, with severe right eye pain and headache for five days, and on physical examination eyelid edema. Was admitted with diagnostic suspicion of post-septal cellulitis versus orbital pseudo-tumor. A high-resolution computer tomography revealed myositis of inferior and medial rectus muscles. The onset of unilateral vesicular eruption along the three dermatomes of the trigeminal nerve occurred only four days later. Ophtalmologic evaluation documented right eye keratitis. History of previous full-blown varicella in the first year of life was found and a positive VZV viraemia was discovered. Treatment with acyclovir resulted on clinical improvement. A complete resolution of the HZO was achieved without sequelae.

Conclusions: Whenever there are vesicular lesions on the nose (Hutchinson´s sign), the risk of HZO is higher, as it indicates the involvement of nasociliary branch of the trigeminal nerve, which also innervates the globe. Although rare in pediatric patients, early diagnosis in these cases is critical to prevent progressive corneal involvement and potential loss of vision.

Keywords: Herpes-Zoster Ophthalmicus, eyelid edema, Varicella-Zoster virus