Severe Herpes Zoster Ophtalmicus in an Immuncompromised Patient

Özet

A 65-year-old male presented with pain and redness on the right side of his face since a few days. On medical history, he underwent bone marrow transplantation from full match donor for AML-M5 3 years ago. He was followed in remission for 2 years. On physical examination, the findings were as follows: temperature was 36.7oC, blood pressure was 110/70 mmHg, and pulse rate was 84/min. Erythema and vesicles were observed on the right frontal area and scalp limited with dermatome of the trigeminal nerve ophthalmic branch (V1) (Figure A). Respiratory and abdominal examinations were normal. Results of laboratory analysis were as follows: neutrophil cell count was 3360/mm3, hemoglobin was 14 mg/dL, creatinine was 1.0 mg/dL, and liver enzymes were normal. Atypical cells were not observed in peripheral blood smear. On cranial computer tomography, bilateral orbital cavity was normal, but an infiltration was observed starting from the right frontal region including periorbital and zygomatic regions. The initial therapy was acyclovir 10 mg/kg provided thrice a day and 4 mg/kg daptomycin. Ophthalmologic examination showed herpetic lesions on the cornea, and topical ganciclovir application was also added to the initial therapy. Vesicular lesions improved on the 14th day of acyclovir treatment (Figure B). After a week cessation of antimicrobial therapy, the patient presented with severe pain in the lesion area. He was diagnosed with postherpetic neuralgia, and antidepressant treatment (duloxetine) was initiated.