Involvement of the mandibular branch of the trigeminal nerve by herpes zoster virus: a case report in pediatrics (Colombia)

Abstract

Introduction: herpes Zoster (HZ) is a disease caused by the reactivation of the varicella-zoster virus (VZV) after remaining latent subsequent to a primary infection. Upon reactivation, it replicates and spreads through the nerve to the corresponding dermatome. It is characterized by intense pain and the appearance of unilateral vesicular lesions distributed along the affected dermatome.

Objectives: present a clinical case identified with involvement of the mandibular branch of the trigeminal nerve due to HZ with negative diagnostic molecular tests, serving as input to favor clinical suspicion and early treatment that improves patient prognosis.

Case Description: 11-year-old adolescent with a history of varicella infection during school age presented with vesicular lesions in the dermatome of the right trigeminal mandibular branch. There was a clinical suspicion of facial herpes, serology for herpes I and herpes II was performed, which came back negative. Polymerase chain reaction (PCR) for varicella-zoster virus was also negative. The patient was treated inpatient with intravenous acyclovir and corticosteroids. Their evolution was favorable, with complete resolution of skin lesions and no trigeminal neuralgia.

Conclusions: the diagnosis of facial HZ is exclusively clinical, and obtaining negative serological tests, while other etiologies have been ruled out, requires early treatment to improve prognosis and reduce sequelae in children.