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A Case With Herpes Zoster Ophthalmicus Mimicking Delayed Complication of Rhinoplasty
Il Gu Jung1, Hahn Jin Jung1, Woo Sub Shim1
1Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
Journal of Rhinology : Official Journal of the Korean Rhinologic Society
|December 12, 2024
Summary
Herpes zoster ophthalmicus (HZO) can mimic surgical complications. Unexplained nasal tip lesions after rhinoplasty may indicate HZO, requiring prompt ophthalmological evaluation and antiviral treatment.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Dermatology
Background:
- Herpes zoster ophthalmicus (HZO) results from varicella zoster virus reactivation in the ophthalmic nerve.
- Hutchinson's sign (nasal tip lesions) predicts ocular involvement due to shared innervation via the nasociliary nerve.
Observation:
- A 44-year-old man presented with nasal tip skin lesions 17 years post-rhinoplasty.
- Initial suspicion of graft infection was investigated.
- Surgical exploration revealed no infection; serology confirmed varicella zoster virus (VZV) infection.
Findings:
- The patient was diagnosed with HZO, initially misdiagnosed as a delayed rhinoplasty complication.
- Treatment with famciclovir led to gradual resolution of the skin lesions.
- Positive VZV IgM and IgG antibodies confirmed the diagnosis.
Implications:
- HZO should be considered in patients with unexplained nasal tip lesions, especially those with a history of rhinoplasty.
- Early diagnosis and antiviral treatment are crucial for managing HZO and preventing ocular complications.
- This case highlights the importance of considering viral reactivation in post-surgical facial presentations.
