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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 2  |  Issue : 3  |  Page : 85-87

Zosteriform herpes simplex infection of V3 dermatome


1 Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
2 Department of Dermatology, Venerology and Leprosy, Acharya Vinoba Bhave Rural College and Hospital, Wardha, Maharashtra, India

Date of Submission27-May-2021
Date of Decision16-Jun-2021
Date of Acceptance08-Jul-2021
Date of Web Publication25-Aug-2021

Correspondence Address:
Mrunal G Meshram
Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcdoh.jpcdoh_24_21

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  Abstract 


Human herpesviruses are prevalent DNA viruses that can cause various orofacial diseases. Diagnosis of herpes simplex virus-induced oral diseases is usually based on the clinical presentation and on the medical history. We hereby present a case of zosteriform herpes simplex infection in an immunocompetent male.

Keywords: Antiviral pharmacotherapy, herpes simplex, herpes zoster, zosteriform herpes simplex


How to cite this article:
Meshram MG, Bhowate RR, Lohe V, Mohod SC, Madke BS. Zosteriform herpes simplex infection of V3 dermatome. J Prim Care Dent Oral Health 2021;2:85-7

How to cite this URL:
Meshram MG, Bhowate RR, Lohe V, Mohod SC, Madke BS. Zosteriform herpes simplex infection of V3 dermatome. J Prim Care Dent Oral Health [serial online] 2021 [cited 2021 Dec 3];2:85-7. Available from: http://www.jpcdoh.org/text.asp?2021/2/3/85/324542




  Introduction Top


Human herpes simplex virus (HSV) is a human neurotropic ubiquitous pathogen that establishes a lifelong latent infection and is associated with mucocutaneous lesions.[1] HSV can occur in association with immunocompromised state.[2] In general, the pathogenesis of HSV infection follows a cycle of primary infection of epithelial cells, latency primarily in neurons, and intermittent reactivation.[3] Zosteriform HSV infection is an uncommon presentation of HSV-1 whereby the rash simulates herpes zoster (HZ). Antiviral treatment of zosteriform HSV and varicella-zoster virus (VZV) differs significantly since former needs lower dose and dosing frequency.


  Case Report Top


A 29-year-old immunocompetent male patient came to the outpatient department in the department of oral medicine with the complaint of painful fluid-filled lesions on the left side of the facial for the past 5 days. He reported eruption of fluid-filled lesions near the left angle of the mouth and left preauricular region. The eruption was associated with intermittent mild pain and burning sensation, especially near the left ear and jaw. He also complained of mild fever and weakness for the past 5 days. There was no prior history of drug intake. On clinical examination, multiple grouped vesicular lesions were noticed on the left side of the lower lip, left corner of the mouth, and left preauricular region and on the concha [Figure 1] and [Figure 2]. On palpation, mild tenderness was present below the left side of the lower lip, left corner of the mouth, and left preauricular region. On the basis of clinical features, diagnosis of zosteriform herpes simplex infection involving left mandibular division of trigeminal nerve (V3) was made. Tzanck smear made from one of the lesions showed typical viral cytopathic findings of epithelial multinucleated giant cells. Routine hemogram, serum biochemistry, and urinalysis were within normal range. Serology for HIV, hepatitis B virus, and hepatitis C virus was negative. The patient was prescribed oral acyclovir 400 mg three times a day and topical acyclovir 5% cream 34 times a day. Topical mupirocin ointment 2% was given to cover bacterial infection. Analgesics and antipyretics (aceclofenac 100 mg and acetaminophen 500 mg) were prescribed for symptomatic relief. The patient responded well to the medication and showed complete healing of eruption within a week [Figure 3] and [Figure 4].
Figure 1: Pre-treatment photograph showing multiple grouped vesicular lesions on left side of lower lip, left corner of mouth

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Figure 2: Post-treatment photographs showing complete healing of lesions

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Figure 3: Pre-treatment photograph showing multiple grouped vesicular lesions left preauricular region and on concha

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Figure 4: Post-treatment photographs showing complete healing of lesions

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  Discussion Top


HSV infection is one of the common viral infections affecting the skin, oral mucosa, and genitalia. Commonly, HSV infection presents as a localized grouped eruption of papulovesicular lesions which progress to superficial erosions with crust and heals without scarring. Uncommonly, HSV can manifest as a zosteriform rash similar to HZ caused by VZV. Aithal et al. have provided a clinical clue to differentiate between zosteriform HSV and HZ.[4] Vesicles of herpes simplex are uniform in size in contrast to the vesicles seen in HZ, which vary in size. Tzanck smear commonly used to diagnose herpesvirus infection cannot differentiate between HSV and VZV infections as both conditions show similar cytopathic events.[5] Ideally, in cases of diagnostic dilemma, real-time nested multiplex polymerase chain reaction can give distinction between HSV-1, HSV-2, and VZV.[6] However, in a resource-poor setting, it is important to differentiate between zosteriform HSV and typical dermatomal rash of HZ (VZV) on clinical grounds. Although both conditions respond to the same antiviral drugs (acyclovir, valacyclovir, and famciclovir), antiviral susceptibility of both viruses differs markedly. VZV infection needs a higher concentration of drugs as it shows less sensitivity to antiviral drugs. Typical acyclovir dosages used for treatment of HSV are 400 mg thrice a day for 5 days while that for VZV infection is 800 mg five times a day for 7–10 days.[7] Our case responded to lower acyclovir dosing, thus confirming the diagnosis of zosteriform HSV infection of the mandibular division of the trigeminal nerve (V3). In addition, it must be emphasized to male patients that they must avoid shaving till the eruption subsides completely since shaving during active infection can lead to herpetic sycosis.[8]

To conclude, it is imperative for a clinician to differentiate between zosteriform herpes simplex infection and HZ rash so that we can prescribe antiviral drugs rationally.

Declaration of patient consent

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Menendez CM, Carr DJ. Defining nervous system susceptibility during acute and latent herpes simplex virus-1 infection. J Neuroimmunol 2017;308:43-9.  Back to cited text no. 1
    
2.
Koley A, Saoji V, Salodkar A. unusual formation of keloids after each episode of recurrent herpes zoster in an HIV positive patient. Indian J Sex Transm Dis 2009;30:109-11.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Kukhanova MK, Korovina AN, Kochetkov SN. Human herpes simplex virus: life cycle and development of inhibitors. Biochemistry (Mosc) 2014;79:1635-52.  Back to cited text no. 3
    
4.
Aithal S, Kuruvila S, Ganguly S. Zosteriform herpes simplex and herpes zoster: A clinical clue. Indian Dermatol Online J 2013;4:369.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Gupta LK, Singhi MK. Tzanck smear: a useful diagnostic tool. Indian J Dermatol Venereol Leprol 2005;71:295-9.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Guda SJ, Sontam B, Bagga B, Ranjith K, Sharma S, Joseph J. Evaluation of multiplex real-time polymerase chain reaction for the detection of herpes simplex virus-1 and 2 and varicella-zoster virus in corneal cells from normal subjects and patients with keratitis in India. Indian J Ophthalmol 2019;67:1040-6.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Koh MJ, Seah PP, Teo RY. Zosteriform herpes simplex. Singapore Med J 2008;49:e59-60.  Back to cited text no. 7
    
8.
Al-Dhafiri SA, Molinari R. Herpetic folliculitis. J Cutan Med Surg 2002;6:19-22.  Back to cited text no. 8
    


    Figures

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



 

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