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Mandibular osteomyelitis and tooth exfoliation following zoster-CMV co-infection
Shabnum Meer1, Hedley Coleman, Mario Altini
1Division of Oral Pathology, Department of Anatomical Pathology, University of the Witwatersrand, Johannesburg, South Africa. shabnum.meer@nhls.ac.za
Abstract:
Herpes zoster is a common viral infection, the oral soft tissue manifestations of which are widely known and recognized. Reports of spontaneous tooth exfoliation and jaw osteonecrosis following herpes zoster infection in the distribution of the trigeminal nerve are extremely infrequent and sporadic, with only 39 cases being reported in the literature. We report an additional case of mandibular osteomyelitis and spontaneous tooth exfoliation following herpes zoster infection, which occurred in the left mandible of a 70-year-old diabetic man; however, our case also showed CMV co-infection. The role of CMV in the pathogenesis of the osteonecrosis remains uncertain. Awareness of the possibility of CMV co-infection in various oral diseases including oral ulcers, Kaposi's sarcoma, and herpes zoster infections especially in immunocompromised patients is important, since spread of the CMV can easily occur to other sites with potentially fatal consequences. Early diagnosis can lead to effective treatment and prevention of complications.
Insights
Herpes zoster can lead to rare jaw osteonecrosis and tooth loss. This case highlights a potential cytomegalovirus (CMV) co-infection, emphasizing the need for awareness in immunocompromised patients.
Area of Science:
- Oral Medicine
- Infectious Diseases
- Pathology
Background:
- Herpes zoster (shingles) commonly affects oral soft tissues.
- Spontaneous tooth exfoliation and jaw osteonecrosis are rare complications of herpes zoster, particularly within the trigeminal nerve distribution.
Observation:
- A case of mandibular osteomyelitis and spontaneous tooth exfoliation following herpes zoster infection in a 70-year-old diabetic male is presented.
- This case also exhibited cytomegalovirus (CMV) co-infection, a factor whose role in osteonecrosis pathogenesis is currently unclear.
Findings:
- The study details an infrequent presentation of herpes zoster complications.
- Cytomegalovirus (CMV) co-infection was identified, suggesting a potential synergistic role or increased susceptibility in immunocompromised individuals.
Implications:
- Increased awareness of CMV co-infection in oral diseases like herpes zoster, especially in immunocompromised patients, is crucial.
- Early diagnosis and management of such co-infections can prevent severe complications and potentially fatal systemic spread of CMV.
- This case underscores the importance of considering co-infections in managing complex oral manifestations of viral diseases.
