Herpes Zoster in Palate: Atypical Presentation in Immunosuppressed Patient Secondary to Rituximab, a Case Report and Review of Clinical Manifestations and Management
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Abstract
Herpes zoster (HZ) is caused by the reactivation of the latent varicella zoster virus (vZv). The cause of reactivation may be associated with predisposing factors such as age, stress or the impaired immune system and an association with autoimmune diseases has been seen. Its clinical presentation is characterized by the appearance of multiple vesicles that rupture quickly, leaving small, very painful ulcers that are distributed respecting specific dermatomes.
The diagnosis in most cases is clinical, and complementary tests may be necessary and differential diagnoses may be excluded in cases of atypical presentation.
The main sequelae after the disappearance of skin signs is postherpetic neuralgia, which is more common in the elderly. Early diagnosis and rapid initiation of treatment determine the prognosis, especially in immunocompromised individuals.
In this work we report a case of atypical clinical presentation in a woman with autoimmune disease, immunocompromised and belonging to the elderly population, being a clear example of the patient in whom special attention should be paid when establishing the diagnosis with the aim of emphasizing early detection and rapid establishment of appropriate treatment, avoiding deleterious outcomes.
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References
I. Nair, P.A.; Patel, B.C. Herpes zoster. In StatPearls [Internet]; StatPearls Publishing: Treasure Island, FL, USA, 2021.
II. Patil A, Goldust M, Wollina U. Herpes zoster: A Review of Clinical Manifestations and Management. Viruses. 2022 Jan 19;14(2):192. doi: 10.3390/v14020192. PMID: 35215786; PMCID: PMC8876683.
III. Kimberlin DW, Whitley RJ. varicella-zoster vaccine for the prevention of herpes zoster. n Engl J Med. 2007; 356:1338–1343.
IV. Jeon YH. Herpes Zoster and postherpetic neuralgia: practical Consideration for prevention and Treatment. The Korean Journal of pain. 2015;28(3):177-184.
V. Cebrian-Cuenca aM, Diez-Domingo J, San-Martin- Rodriguez M, Puig-Barbera J, Navarro-Perez J. Epidemiology and cost of herpes zoster and postherpetic neuralgia among patients treated in primary care centres in the valencian community of Spain. BMC infect Dis. 2011;11(1):1-12.
VI. Huang, C.-T.; Lee, C.-Y.; Sung, H.-Y.; Liu, S.-J.; Liang, P.-C.; Tsai, M.-C. Association between Diabetes Mellitus and the Risk of Herpes zoster: A Systematic Review and Meta-analysis. J. Clin. Endocrinol. Metab. 2021, 107, 586–597.
VII. Harpaz R, Leung JW, Brown CJ, Zhou FJ. psychological stress as a trigger for herpes zoster: might the conventional wisdom be wrong? Clin infect Dis 2015; 60:781–785.
VIII. Neves oS, Faco MMM, Sallum aME, Campos LMa, Rossi Junior a, Silva Caa. Herpes-zoster em pacientes com lupus eritematoso sistemico juvenil. Rev Bras Reumatol. 2007; 47(2):135-9.
IX. Nagel Ma, Gilden D. varicella Zoster Complications. Current treatment options in neurology. 2013; 15(4):439-453.
X. Jung HS, Kang JK, Yoo SH. Epidemiological Study on the incidence of Herpes Zoster in nearby Cheonan. The Korean Journal of pain. 2015; 28(3):193-197.
XI. Boza-Oreamuno Yadira, Herpes zoster on tHe palate: case report with literature review. Rev. Cient. Odonto 2016; Vol.12 / No. 2 (41-45).
XII. Murugaiyan Rangaraj , Oral sores: a rare presentation of Herpes zoster. Ge Geriatric Care 2016; volume 2:5964
XIII. Yawn Bp, Wollan pC, Kurland MJ, St Sauver JL, Saddier p. Herpes zoster recurrences more frequent than previously reported. Mayo Clin proc 2011;10
XIV. Carbone v, Leonardi a, pavese M, Raviola E, Giordano M. Herpes zoster of the trigeminal nerve: a case report and review of the literature. Minerva Stomatol. 2004;53(1-2):49–59.
XV. Marin M, Harpaz R, Zhang J, Wollan pC, Bialek SR, Yawn Bp. Risk Factors for Herpes Zoster among adults. open Forum infectious Diseases. 2016; 3(3):ofw119.
XVI. Koo, B.S.; Lim, Y.-C.; Lee, M.-Y.; Jeon, J.-Y.; Yoo, H.-J.; Oh, I.-S.; Shin, J.-Y.; Kim, T.-H. The risk factors and incidence of major infectious diseases in patients with ankylosing spondylitis receiving tumor necrosis factor inhibitors. Mod. Rheumatol. 2021, 31, 1192–1201.
XVII. Zou, A.; Chen, Y.; Shi, N.; Ye, Y. Risk of Herpes zoster associated with biological therapies for psoriasis and psoriatic arthritis. Medicine 2021, 100, e27368.
XVIII. Winthrop, K.L.; Nash, P.; Yamaoka, K.; Mysler, E.; Khan, N.; Camp, H.S.; Song, Y.; Suboticki, J.L.; Curtis, J. R Incidence and risk factors for Herpes zoster in patients with rheumatoid arthritis receiving upadacitinib: A pooled analysis of six phase III clinical trials. Ann. Rheum. 2021, epub ahead of print.