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Year : 1973  |  Volume : 21  |  Issue : 3  |  Page : 131-133

Herpes zoster ophthalmicus followed by varicella in a young adult


Department of Ophthalmology and Medicine Jawaharlal Nehru Medical College & Hospital, Raipur, India

Correspondence Address:
I M Shukla
Department of Ophthalmology and Medicine Jawaharlal Nehru Medical College & Hospital, Raipur
India
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Source of Support: None, Conflict of Interest: None


PMID: 4549850

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How to cite this article:
Shukla I M, Tiwari S K, Billore O P. Herpes zoster ophthalmicus followed by varicella in a young adult. Indian J Ophthalmol 1973;21:131-3

How to cite this URL:
Shukla I M, Tiwari S K, Billore O P. Herpes zoster ophthalmicus followed by varicella in a young adult. Indian J Ophthalmol [serial online] 1973 [cited 2021 May 8];21:131-3. Available from: https://www.ijo.in/text.asp?1973/21/3/131/31388

Varicella and Herpes Zoster are two facets of a disease caused by the same virus. Clinically, however, the manifestations of zoster and chicken pox are still a matter of chance and conjecture. It is not clear which factors determine the appearance of one or the other forms of the disease after exposure to the virus. STOKES [7] is of the view that varicella can be regarded as an early generalised infec­tion, while zoster is a late and more localised manifestation in the fully immune or partially-immune person, at a later age probably due to reactiva­tion of the virus. This, however, does not explain- the appearance of chicken pox rash after the initial attack of zoster. KNYVETT et al [4] and ROTEM [2] reported two cases wherein chicken pox developed seven days and three days respectively after an attack of herpes zoster ophthal­micus.

The present case is of particular interest because of the herpetic involvement of the ophthalmic as well as maxillary divisions of the trigeminal nerve in a young male followed two days later by the appearance of chicken pox rash.


  Case Report Top


A 25-year old hindu male came to our ophthalmic department on 14th September, 1970, complaining of pain and eruptions in the distributions of the ophthalmic and maxillary divisions of the right trigeminal nerve. [Figure - 1] There were also vesicles on the buccal mucosa and soft palate. There was no history of previous contact with varicella or zoster cases. The patient did not suffer from any other infec­tion or injury or from chicken pox in the immediate past and he was afebrile, the pulse and blood pressure were normal, and there was no lymphadenopathy.

Ocular Examination

Right eye revealed vesicles on the lids with marked circumcorneal injection and a corneal ulcer at 2 O'clock position with dull corneal sensitivity. The iris and anterior chamber were normal. The pupil was circular and reacted normally. The visual acuity was 6/6. Left eye showed a normal conjunctiva, cornea, anterior chamber and iris. The visual acuity was 6/6.

Laboratory Investigations - Total W.B.C. Count - 7,800/cmm. Dif­ferential W.B.C. Count-Neutrophils -65%, and lymph-35%. E.S.R.­21 mm. fall at the end of the first hour (by Westergreen's Method).

Urine analysis-Nomal.

Progress - Two
days after the admission, inspite of treatment, the patient developed varicelliform-erul­tion, with a centripetal distribution chiefly on the back and chest. [Figure - 2]. The patient remained afebrile. Crust formation occurred five days after hospitalisation. The corneal ulcer healed in five days, the eye became normal. Post herpetic pain persisted for about a month after the crusts fell off, and came again under treatment.

Treatment - Tetracycline capsule one gm. daily for ten days. Injection Vit. B 1 (Thaimine) 100 mg. Vit. B 12 (Cyanocobalamine) 1000 micro gm. on alternate days. Atropine and terramycine eye ointments were applied twice on the right eye.

Calamine lotion was applied on the varicella on face. Analgesics and sedatives were given for the relief of pain.


  Discussion Top


The occurrence of a varicelliform rash in the course of herpes zoster is a well-known entity. It is variously referred to as zoster generalised or zoster universalis and varicilliform zoster. The condition was probably first described by TENNESON in 1893 and many examples have been recorded since. MINET AND LECLEREA [8] collected 25 cases. PARKER WEBER described several cases and quoted 20 references. Most reports stress its occurrence in elderly patients.

It has been assumed by some writers that the erruption constitutes a true attack of chicken pox [8] or that the occurrence of the two conditions is a proof that zoster and varicella are but two faces of one and the same disease. But PARKER WEBER has pointed out that this conclusion is hardly justified as, some of the cases indicate only few aberrent vesicles, and evidence of an increase is lacking in the cases of zoster during epidemics of varicella.

Clinically simultaneous occurrence of herpes zoster and chickenpox is very rare and factors influencing such conditions are not established. GARRETT, [2] PARKINSON [6] respectively reported two cases of simultaneous occurrence in a girl aged 3½ years and a boy aged 8 years. KNYETT,[4] however, reported the same pheno­menon in two elderly patients. As far as we know no such cases of simultaneous occurrence of zoster and varicella have been reported in India. Moreover, the involvement of second division of the trigeminal along with all branches of the ophthalmic is a rare combination seen in this case[9].


  Summary Top


An unusual case of simultaneous occurrence of Herpes Zoster ophthal­micus involving the ophthalmic and maxillary divisions of the trigeminal nerve followed two days later by generalised chicken pox in a male aged 25 years is reported.

 
  References Top

1.
Birks A. D.: Brit. Med. J., 47: 60, (1963).  Back to cited text no. 1
    
2.
Chava E. Rotem.: Brit. Med. J., April 1, 1946, (1961).  Back to cited text no. 2
    
3.
Garrett F. E.: Amer. J. Ophth. 46: 741, (1958).  Back to cited text no. 3
    
4.
Knyvett A. F.: Med. J. Aust. 1: 91, (1957).  Back to cited text no. 4
    
5.
Maccallum: The Practitioner, 183: 592, (1959).  Back to cited text no. 5
    
6.
Parkinson T.: Brit. Med. J. 1: 8, (1948).  Back to cited text no. 6
    
7.
Stokes J.: Viral and Rickettsial Infection of Man, 3rd Edition, pp. 773.  Back to cited text no. 7
    
8.
Allen F.M.B.: Brit. Med. J. 2, 115, 1944. Quoted by Parkinson T. Brit. Med. J. 1: 8, 1948.  Back to cited text no. 8
    
9.
Manning: Brit. Med. J. 2, 115, 1944. Quoted by Parkinson T. Brit. Med. J. 1: 8, 1948.  Back to cited text no. 9
    


    Figures

  [Figure - 1], [Figure - 2]



 

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