Zona zoster; an atypical presentation with severe pre-lesion pain: a case report

Year 2023, Volume: 4 Issue: 6, 715 - 717, 31.12.2023

Rıdvan Erdin , Bahtin Atakan Soysal Merve Dilcan

https://doi.org/10.47582/jompac.1398243

Abstract

Varicella zoster virus (VZV) is an alpha herpesvirus with a double-stranded DNA genome. VZV infects humans, and its primary targets are T lymphocytes, epithelial cells, and ganglia. The primary infection results in chickenpox, during which VZV becomes latent in ganglionic neurons.

Keywords

Zona zoster, alpha herpesvirus, ganglionic neurons

Zona zoster; an atypical presentation with severe pre-lesion pain: a case report

Abstract

The Varicella Zoster virus can initially cause chickenpox in humans and then become latent. It can later reactivate for various reasons and manifest as shingles in dermatome areas, characterized by redness, rash, and neuropathic pain. In this case, we want to highlight a Zoster case with atypical symptoms resembling acute coronary syndrome, but without the presence of a rash. The patient is a 78-year-old female who presented to the emergency department with complaints of chest pain resembling acute coronary syndrome.

Keywords

Differential diagnosis, atypical zona, acute coronary syndrome

References

• Kennedy PG. Varicella‐zoster virus latency in human ganglia. Rev Med Virol. 2002;12(5):327-334.
• Nagel MA, Gilden DH. The protean neurologic manifestations of varicella-zoster virus infection. Cleveland Clin J Med. 2007; 74(7):489.
• Gilden D, Cohrs RJ, Mahalingam R, Nagel MA. Neurological disease produced by varicella zoster virus reactivation without rash. Varicella-zoster Virus. 2010:243-253. doi.org/10.1007/82_2009_3
• Gershon AA, Gershon MD. Pathogenesis and current approaches to control of varicella-zoster virus infections. Clin Microbiol Rev. 2013;26(4):728-743.
• Furuta Y, Ohtani F, Aizawa H, Fukuda S, Kawabata H, Bergström T. Varicella-zoster virus reactivation is an important cause of acute peripheral facial paralysis in children. Pediatr Infect Dis J. 2005;24(2):97-101.
• Breuer J, Pacou M, Gautier A, Brown MM. Herpes zoster as a risk factor for stroke and TIA: a retrospective cohort study in the UK. Neurol. 2014;83(2):e27-e33.
• Patil A, Goldust M, Wollina U. Herpes zoster: a review of clinical manifestations and management. Viruses. 2022;14(2):192.
• Zhou J, Li J, Ma L, Cao S. Zoster sine herpete: a review. Korean J Pain. 2020;33(3):208-215.
• Tyring SK, Beutner KR, Tucker BA, Anderson WC, Crooks RJ. Antiviral therapy for herpes zoster: randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Arch Fam Med. 2000;9(9):863.
• McDonald EM, de Kock J, Ram FS. Antivirals for management of herpes zoster including ophthalmicus: a systematic review of high-quality randomized controlled trials. Antiviral Ther. 2012;17(2):255-264.
• Lin W, Lin H, Lee S, et al. Comparative study of the efficacy and safety of valaciclovir versus acyclovir in the treatment of herpes zoster. J Microbiol Immunol Infect= Wei Mian yu gan ran za zhi. 2001;34(2):138-142.
• Gershon AA, Breuer J, Cohen JI, et al. Varicella zoster virus infection. Nature Rev Dis Primers. 2015;1(1):1-18.
• Whitley RJ, Weiss H, Gnann Jr JW, et al. Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial. Ann Internal Med. 1996;125(5):376-383.
• Han Y, Zhang J, Chen N, He L, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Systematic Rev. 2013;3:1-33.
• Forbes HJ, Bhaskaran K, Thomas SL, Smeeth L, Clayton T, Langan SM. Quantification of risk factors for herpes zoster: population based case-control study. BMJ. 2014;348:g2911. doi.org/10.1136/bmj.g2911
• Chen JJ, Zhu Z, Gershon AA, Gershon MD. Mannose 6-phosphate receptor dependence of varicella zoster virus infection in vitro and in the epidermis during varicella and zoster. Cell. 2004;119(7):915-926.
• Yang Y, Mahmood T, Siddiqui AH, Aziz MA. Zoster sine herpete: two unusual cases of varicella-zoster reactivation with atypical complaints of acute chest pain and severe headache. BMC Infect Dis. 2023;23(1):239. doi:10.1186/s12879-023-08093-3
• Drago F, Herzum A, Ciccarese G, Broccolo F, Rebora A, Parodi A. Acute pain and postherpetic neuralgia related to Varicella zoster virus reactivation: comparison between typical herpes zoster and zoster sine herpete. J Med Virol. 2019;91(2):287-295.
• Chen WH, Chui C, Yin HL. Zoster sine herpete, vertebral artery stenosis, and ischemic stroke. J Stroke Cerebrovasc Dis. 2013;22(7):e234-e237.
• Ibraheem M, Marin M, Leung J, et al. Fatal wild-type varicella-zoster virus encephalitis without a rash in a vaccinated child. Pediatr Infect Dis J. 2013;32(2):183-185.