title: A pox upon your house.
abstract: Herpes zoster ophthalmicus (HZO) is a common viral infectious disorder affecting the ophthalmic division of the trigeminal nerve. A small subset of HZO patients present with the ophthalmic symptoms, but without an accompanied rash, a condition described as Herpes zoster sine herpete. Although HZO is well known to be associated with other central nervous system abnormalities, encephalitis and cerebral infarction are atypical and uncommon. We report an unusual case of presumed unilateral Herpes zoster ophthalmicus sine herpete that presented with trigeminal pain and uveitis and then progressed to encephalitis and bilateral cerebral infarctions despite treatment with acyclovir and corticosteroids. The diagnosis of HZV was confirmed by polymerase chain reaction testing on the cerebrospinal fluid.
authors.affiliation: Department of Ophthalmology, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Nafiseh
authors.initials: N
authors.lastname: Hashemi
authors.forename: Jason
authors.initials: J
authors.lastname: Zhang
authors.forename: John
authors.initials: J
authors.lastname: Volpi
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Lee
authors.forename: Lynn K
authors.initials: LK
authors.lastname: Gordon
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D002555:Cerebrospinal Fluid / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D020804:Encephalitis, Varicella Zoster / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D058447:Eye Pain / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D005938:Glucocorticoids / Q000627:therapeutic use; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016133:Polymerase Chain Reaction; D014606:Uveitis, Anterior / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology
chemical_list: D004279:DNA, Viral; D005938:Glucocorticoids; D000212:Acyclovir
keywords: cerebral infarction; encephalitis; herpes zoster ophthalmicus; herpes zoster sine herpete; uveomeningeal syndrome