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PHOTO ESSAY
Year : 2020  |  Volume : 68  |  Issue : 1  |  Page : 202-203

Late onset DCR surgical site herpes zoster in an immunocompetent patient: A rare presentation


Department of Oculoplasty, Sankara Eye Hospital, Jaipur, Rajasthan, India

Date of Submission26-May-2019
Date of Acceptance02-Sep-2019
Date of Web Publication19-Dec-2019

Correspondence Address:
Dr. E Vivek Chaitanya
Sankara Eye Hospital, Plot No. 6, Sector 6, Vidhyadhar Nagar, Jaipur - 302 023, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1007_19

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  Abstract 


Keywords: Acyclovir, dacryocystorhinostomy, herpes zoster, shingles


How to cite this article:
Chaitanya E V, Shruthi T V, Shah NA. Late onset DCR surgical site herpes zoster in an immunocompetent patient: A rare presentation. Indian J Ophthalmol 2020;68:202-3

How to cite this URL:
Chaitanya E V, Shruthi T V, Shah NA. Late onset DCR surgical site herpes zoster in an immunocompetent patient: A rare presentation. Indian J Ophthalmol [serial online] 2020 [cited 2020 Aug 14];68:202-3. Available from: http://www.ijo.in/text.asp?2020/68/1/202/273175



A 30-year-old female presented to us with watering in right eye (RE) since 12 months. The best corrected visual acuity in both eyes was 20/20. Anterior segment was unremarkable in both eyes except that regurgitation on pressure over lacrimal sac area in RE was positive. A diagnosis of primary acquired nasolacrimal duct obstruction was made for which dacryocystorhinostomy (DCR) was advised and carried out uneventfully. HIV/HbsAg/HCV assays were negative. The patient was discharged with steroid-antibiotic combination drops, antibiotic ointment, systemic antibiotics, NSAIDs, and nasal decongestants. At 2-week follow-up, sutures were removed. After 2 weeks, the patient presented with painful swelling over the lacrimal sac area. The patient was continued on antibiotic eye ointment and tablet trypsin/chymotrypsin was added. After 1 week, a 3-mm single abscess was noted over the wound. The abscess suspected to be due to secondary bacterial infection was drained under aseptic precaution and oral antibiotic was re-started. Multiple abscesses were noted over the wound site after 1 week [Figure 1]. The patient was started on intravenous cefotaxime (1 gram) BD for 3 days. Mantoux, chest X-ray, and sputum culture for AFB were negative. Coalescent vesicles were seen over the wound site after 3 days [Figure 2]. Lacrimal irrigation in RE was patent. Gram stain, KOH mount, and Ziehl-Nielsen stain all were negative for pus collected from the site. Clinical impression of surgical site herpes zoster was made with dermatologist consult. The patient was started on tablet acyclovir (800 mg) 5 times a day and acyclovir cream (5%) over wound area. After 7 days, a dramatic decrease in the size and number of vesicles were observed [Figure 3]. After 1 month of initiating anti-viral therapy, the wound site was completely healthy and no herpetic lesion was noted [Figure 4].
Figure 1: Slit lamp photo depicting multiple vesicles around DCR wound

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Figure 2: Slit lamp photo showing increase in size and number of vesicles

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Figure 3: Slit lamp photo showing decrease in the size and number of vesicles after initiating antiviral therapy

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Figure 4: Slit lamp photo depicting complete resolution of the lesion and a clean healed wound

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  Discussion Top


Herpes zoster was reported within scar of a recent facial operation.[1] Corticosteroid injections,[2] botulinum toxin injections,[3] radiotherapy,[4] and cryosurgery [5] can incite shingles.


  Discussion Top


Histopathology and viral culture/PCR were lacking to support our clinical diagnosis. The lack of DCR surgical site herpes zoster related reports make this case one of its kind and an eye opener for future references.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Choi HJ, Kim JH, Lee YM. Herpes zoster developing within recent subciliary incision scar. J Craniofac Surg 2012;23:930-1.  Back to cited text no. 1
    
2.
Fernandes NF, Malliah R, Stitik TP, Rozdeba P, Lambert WC, Schwartz RA. Herpes zoster following intra-articular corticosteroid injection. Acta Dermatovenerol Alp Pannonica Adriat 2009;18:28-30.  Back to cited text no. 2
    
3.
Graber EM, Dover JS, Arndt KA. Two cases of herpes zoster appearing after botulinum toxin type a injections. J Clin Aesthet Dermatol 2011;4:49-51.  Back to cited text no. 3
    
4.
Dunst J, Steil B, Furch S, Bormann G, Marsch W. Herpes zoster in breast cancer patients after radiotherapy. Strahlenther Onkol 2000;176:513-6.  Back to cited text no. 4
    
5.
Lee MR, Ryman W. Herpes zoster following cryosurgery. Australas J Dermatol 2005;46:42-3.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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