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Lateral sinus thrombosis associated with zoster sine herpete
James Chan1, Richard T Bergstrom, Donald C Lanza
1Department of Otolaryngology and Communicative Disorders, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
American Journal of Otolaryngology
|August 31, 2004
Summary
This case report details a rare instance of lateral sinus thrombosis (LST) occurring with zoster sine herpete (ZSH), a shingles variant without rash. Early recognition of VZV-associated LST is crucial for prompt antiviral treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Vascular Medicine
Background:
- Herpes zoster is caused by varicella zoster virus (VZV) reactivation.
- Zoster sine herpete (ZSH) is an uncommon VZV manifestation lacking the typical rash.
- Lateral sinus thrombosis (LST) is a serious condition often linked to middle ear infections.
Observation:
- A 55-year-old woman presented with C2 dermatomal pain, nausea, and photophobia, but no rash.
- Imaging revealed left lateral and sigmoid dural sinus thrombosis.
- Elevated VZV-specific antibodies were detected; hypercoagulable studies were normal.
Findings:
- The patient was diagnosed with ZSH and LST.
- Treatment included Neurontin, acyclovir, and anticoagulation.
- Symptoms improved, and the patient was discharged.
Implications:
- This case suggests a potential link between ZSH and LST, possibly due to VZV-associated thrombophlebitis.
- Highlights the importance of considering VZV infection in non-septic LST cases.
- Prompt diagnosis and antiviral therapy are critical for managing this rare complication.