Postoperative abdominal herpes zoster complicated by intestinal obstruction:A case report

BACKGROUND Intestinal obstruction is a common occurrence in clinical practice.However,the occurrence of herpes zoster complicated by intestinal obstruction after abdominal surgery is exceedingly rare.In the diagnostic and treatment process,clinicians consider it crucial to identify the primary causes of its occurrence to ensure effective treatment and avoiding misdiagnosis.CASE SUMMARY Herein,we present the case of a 40-year-old female patient with intestinal obstruction who underwent laparoscopic appendectomy and developed herpes zoster after surgery.Combining the patient's clinical manifestations and relevant laboratory tests,it was suggested that the varicella zoster virus reactivated during the latent period after abdominal surgery,causing herpes zoster.Subsequently,the herpes virus invaded the visceral nerve fibers,causing gastrointestinal dysfunction and loss of intestinal peristalsis,which eventually led to intestinal obstruction.The patient was successfully treated through conservative treatment and antiviral therapy and subsequently discharged from the hospital.CONCLUSION Pseudo-intestinal obstruction secondary to herpes zoster infection is difficult to distinguish from mechanical intestinal obstruction owing to various causes.In cases of inexplicable intestinal obstructions,considering the possibility of a viral infection is essential to minimize misdiagnosis and missed diagnoses。

Superior laryngeal nerve block for treatment of throat pain and cough following laryngeal herpes zoster:A case report

BACKGROUND Herpes zoster is caused by reactivation of latent varicella-zoster virus infection within the sensory nerve ganglion of the spinal or cranial nerves.Laryngeal herpes zoster is rare and involves superior laryngeal nerve,which leads to several complications such as throat pain,and cough.CASE SUMMARY Patient concerns:A 52-year old woman presented with a 70 d history of throat pain and a 67 d history of non-productive cough.Three days after onset of pain,she was diagnosed with laryngeal herpes zoster.Flexible nasolaryngoscopy revealed multiple white ulcerated lesions on the left hemi epiglottis and the left supraglottic area.She was prescribed with 750 mg famciclovir a day for 7 d,and 150 mg pregabalin,100 mg tramadol and 10 mg nortriptyline a day for 67 d.However,despite of these medications,she complained of pain and persistent cough.Therefore,superior laryngeal nerve block under ultrasound guidance was performed.Three days after the intervention,the throat pain and cough disappeared.The patient remained symptom-free at 3 mo follow-up.CONCLUSION A superior laryngeal nerve block can be an effective option for treatment of pain and cough following laryngeal herpes zoster.

Transverse myelitis caused by herpes zoster following COVID-19 vaccination:A case report

BACKGROUND Transverse myelitis(TM)is characterized by sudden lower extremity progressive weakness and sensory impairment,and most patients have a history of advanced viral infection symptoms.A variety of disorders can cause TM in association with viral or nonviral infection,vascular,neoplasia,collagen vascular,and iatrogenic,such as vaccination.Vaccination has become common through the global implementation against coronavirus disease 2019(COVID-19)and reported complications like herpes zoster(HZ)activation has increased.CASE SUMMARY This is a 68-year-old woman who developed multiple pustules and scabs at the T6-T9 dermatome site 1 wk after vaccination with the COVID-19 vaccine(Oxford/AstraZeneca([ChAdOx1S{recombinant}]).The patient had a paraplegia aggravation 3 wk after HZ symptoms started.Spinal magnetic resonance imaging(MRI)showed transverse myelitis at the T6–T9 Level.Treatment was acyclovir with steroids combined with physical therapy.Her neurological function was slowly restored by Day 17.CONCLUSION HZ developed after COVID-19 vaccination,which may lead to more severe complications.Therefore,HZ treatment itself should not be delayed.If neurological complications worsen after appropriate management,an immediate diagnostic procedure,such as magnetic resonance imaging and laboratory tests,will start and should treat the neurological complications.

Value of Chuanjin Qinggan decoction in improving the depressive state of patients with herpes zoster combined with depression

BACKGROUND Western medicine is beneficial for the recovery of neurological function in patients with depression,but some patients experience side effects such as headaches,dizziness,nausea,gastrointestinal symptoms,insomnia,and cardiac dysfunction.In recent years,integrative medicine has achieved positive results in the treatment of various diseases.AIM To study Chuanjin Qinggan decoction combined with selective serotonin reuptake inhibitors(SSRIs)in patients with herpes zoster complicated by depression.METHODS Patients with herpes zoster complicated by depression who were treated at the Yantai Hospital of Traditional Chinese Medicine from January 2021 to December 2022 were retrospectively selected as research participants.Among them,43 patients with herpes zoster complicated by depression who received SSRI treatment between January and December 2021 were assigned to the Western medicine group,while those who received combined treatment of traditional Chinese and Western medicine between January and December 2022 were assigned to the combined group.Both groups were treated for eight weeks.The degree of pain,effect of herpes zoster treatment,degree of improvement in depressive symptoms,serum neurotransmitter levels,sleep quality,and occurrence of adverse reactions were compared between the two groups.RESULTS We found that after eight weeks of drug treatment,the two treatment schemes achieved differing efficacy.In further comparison,we found that,compared with patients treated with SSRIs alone,patients treated with Chuanjin Qinggan decoction combined with SSRIs showed more significant improvement in depression and a greater increase in dopamine and 5-hydroxytryptamine levels after treatment(P<0.05).Patients treated with Chuanjin Qinggan decoction combined with SSRIs also experienced lower pain,better treatment efficacy for herpes zoster,better sleep quality,and a lower incidence of adverse reactions compared to those treated with SSRIs alone(P<0.05).All minor adverse reactions occurring during treatment were resolved after symptomatic treatment.CONCLUSION The treatment scheme of Chuanjin Qinggan decoction combined with SSRIs can improve the psychological state of patients with herpes zoster complicated by depression and alleviate adverse reactions.

Trigeminal extracranial thermocoagulation along with patientcontrolled analgesia with esketamine for refractory postherpetic neuralgia after herpes zoster ophthalmicus:A case report

BACKGROUND Primary trigeminal neuralgia can achieve satisfactory results through clinical treatment and intervention.The pathogenesis of neuralgia caused by varicellazoster virus infection of the trigeminal nerve is more complex,and it is still difficult to relieve the pain in some patients simply by drug treatment or surgical intervention.CASE SUMMARY A 66-year-old woman was hospitalized with herpetic neuralgia after herpes zoster ophthalmicus(varicella-zoster virus infects the ophthalmic branch of the trigeminal nerve).On admission,the patient showed spontaneous,electric shocklike and acupuncture-like severe pain in the left frontal parietal region,and pain could be induced by touching the herpes area.The numerical rating scale(NRS)was 9.There was no significant pain relief after pulsed radiofrequency and thermocoagulation of the ophthalmic branch of the trigeminal nerve.Combined with patient-controlled intravenous analgesia(PCIA)with esketamine,neuralgia was significantly improved.The patient had no spontaneous pain or allodynia at discharge,and the NRS score decreased to 2 points.The results of follow-up 2 mo after discharge showed that the NRS score was≤3,and the Pittsburgh Sleep Quality Index score was 5 points.There were no adverse reactions.CONCLUSION Trigeminal extracranial thermocoagulation combined with esketamine PCIA may be a feasible method for the treatment of refractory herpetic neuralgia after herpes zoster ophthalmicus.

Complete recovery of herpes zoster radiculopathy based on electrodiagnostic study:A case report

BACKGROUND Herpes zoster is a painful infectious disease caused by the varicella zoster virus.Herpes zoster radiculopathy,which is a type of segmental zoster paresis,can complicate the disease and cause motor weakness.This complication should be considered when a patient with a rash complains of acute-onset motor weakness,and the diagnosis can be verified via electrodiagnostic study.CASE SUMMARY A 64-year-old female with a history of asthma presented to the emergency department with stabbing pain,an itching sensation,and a rash on the right anterior shoulder that had begun 5 d prior.Physical examination revealed multiple erythematous grouped vesicles in the right C4-5 and T1 dermatome regions.Because herpes zoster was suspected,the patient immediately received intravenous acyclovir.On the third hospital day,she complained of motor weakness in the right upper extremity.Magnetic resonance imaging of the cervical spine revealed mild intervertebral disc herniation at C4-C5 without evidence of nerve root compression.On the 12th hospital day,electrodiagnostic study revealed right cervical radiculopathy,mainly in the C5/6 roots.Six months later,monoparesis resolved,and follow-up electrodiagnostic study was normal.CONCLUSION This case emphasizes that clinicians should consider the possibility of postherpetic paresis,such as herpes zoster radiculopathy,and that electrodiagnostic study is useful for diagnosis and follow-up.

Resolution of herpes zoster-induced small bowel pseudo-obstruction by epidural nerve block:A case report

BACKGROUND When herpes zoster is complicated with paralytic ileus,this mostly involves acute intestinal pseudo-obstruction of Ogilvie’s syndrome manifesting as obvious dilatation of the cecum and right colon;small intestinal obstruction is rare.Here,we present a patient with a very rare case of small bowel pseudo-obstruction.CASE SUMMARY A 76-year-old female patient complained of right upper quadrant pain.Two days later,a blistering,right-sided rash of the thoracoabdominal dermatome(T5-T10) emerged in conjunction with small intestinal dilatation and the inability to defecate.Computed tomography of the abdomen confirmed small bowel pseudoobstruction.Antiviral therapy,gastrointestinal decompression,and enemas proved unproductive.After 4 d of stagnation,an epidural block was performed for pain relief and prompted the passage of gas and stool,resolving the obstructive problem.Three days later,the rash appeared dry and crusted,and the pain diminished.After 5 d,no abnormality was visible by gastroenteroscopy,and the patient was discharged on day 7.CONCLUSION This case shows that herpes zoster may induce small bowel pseudo-obstruction in addition to colonic pseudo-obstruction.Epidural block can not only treat intercostal neuralgia but also resolve small bowel pseudo-obstruction caused by herpes zoster.

Elevated serum nitric oxide and hydrogen peroxide levels as potential valuable predictors of herpes zoster

Objective:To evaluate the biomarkers of oxidative stress in herpes zoster patients compared with control subjects.Methods:This study compared the nitric oxide(NO),hydrogen peroxide(H2 O2),malon dialdehyde,uric acid,and bilirubin levels between 43 herpes zoster patients and 47 age-matched control subjects.The area under the curve of the receiver operating characteristic curve was performed to evaluate the final logistic regression model.Results:The significant differences were observed in the serum levels of NO,H2 O2,and malondialdehyde between the case and the control groups(P<0.001).However,no statistical differences were found in both uricacid and bilirubin levels between the groups.Additionally,the raised oxidant biomarkers were strongly associated with increased disease severity(P<0.001).Multiple logistic regression analysis with the highest area under the curve[0.98(95%CI 0.95-1.00)]and the minimum number of variables showed that high levels of NO(OR 1.24;95%CI 1.06-1.46;P=0.008)and H2 O2(OR 1.25;95%CI 1.09-1.43;P=0.001)were associated with herpes zoster.Conclusions:High levels of NO and H2 O2 were observed in patients with herpes zoster.Increased NO and H2 O2 levels might be associated with herpes zoster,which needs to be confirmed by further studies.

Rehabilitation of shoulder paresis caused by herpes zoster according to the International Classification of Functioning, Disability and Health A case report

We describe the case of a 73-year-old man with left shoulder paresis caused by a herpes zoster infection of the left C5 dermatomes. The patient had been affected by pain for 10 days, a skin rash on his left shoulder and back for 5 days, and weakness of his left shoulder for 2 days before admission. Eiectromyography revealed denervation discharges from the left supraspinatus, infraspinatus and deltoid muscles, which was compatible with radiculopathy showing after zoster infection. The patient was examined in accordance with the International Classification of Functioning, Disability and Health, and treated with range-of-movement and strengthening exercises as well as activities of daily living and social participation. At 14 months after the onset of the condition, muscle strength had returned to normal. Electromyography revealed that motor unit action potentials were largely normal. These results indicate that the rehabilitation of paresis caused by herpes zoster can obtain positive results with suitable movement training.

Surrounding Needling with Fire Needle and Filiform Needle Plus Moxibustion in the Treatment of Lower Limb Herpes Zoster:One Case Report

Introduction Herpes zoster is a skin disease caused by activation of the varicella zoster virus,which is latent in neurons.It can be accompanied by severe neuralgia.Some herpes zoster patients may have pain allergy,general discomfort,loss of appetite and other prodromal symptoms,typical clinical manifestation as a cluster of blisters distribution along unilateral peripheral nerve,often accompanied by obvious neuralgia[1].

Transverse myelitis after infection with varicella zoster virus in patient with normal immunity: A case report

BACKGROUND Varicella zoster virus(VZV)is a human neurotropic and double-stranded DNA alpha-herpes virus.Primary infection with VZV usually occurs during childhood,manifesting as chickenpox.Reactivation of latent VZV can lead to various neurological complications,including transverse myelitis(TM);although cases of the latter are very rare,particularly in newly active VZV infection.CASE SUMMARY We report here an unusual case of TM in a middle-aged adult immunocompetent patient that developed concomitant to an active VZV infection.The 46-year-old male presented with painful vesicular eruption on his left chest that had steadily progressed to involvement of his back over a 3-d period.Cerebrospinal fluid testing was denied,but findings from magnetic resonance imaging and collective symptomology indicated TM.He was administered antiviral drugs and corticosteroids immediately but his symptom improvement waxed and waned,necessitating multiple hospital admissions.After about a month of repeated treatments,he was deemed sufficiently improved for hospital discharge to home.CONCLUSION VZV myelitis should be suspected when a patient visits the outpatient pain clinic with herpes zoster showing neurological symptoms.

Ocular manifestation and visual outcomes in herpes zoster ophthalmicus:a prospective study from a tertiary hospital of Eastern India

AIM:To estimate the magnitude of different ocular manifestation in clinically established herpes zoster ophthalmicus(HZO)patients and assessment of the visual outcome after two months of initial examination.METHODS:An observational prospective study was conducted on 42 clinically diagnosed Tzanck smear positive cases HZO to observe the occurrence and frequency of different ocular manifestation and their visual outcome in 10-month period with 2mo follow up.Full ophthalmological examination using slit lamp,non-contact tonometry,applanation tonometry,direct and indirect ophthalmoscope were performed.RESULTS:Out of 42 patients of HZO,33 had one or more type of ocular manifestation staring from lid skin involvement to conjunctivitis,keratitis,uveitis,increased intraocular pressure(IOP)and optic neuritis but no retinal manifestation.More number of HZO cases and ocular manifestation were found with advancement of ages.Young HZO patients were more associated with human immunodeficiency virus(HIV)infection and HIV infected people with HZO infection had more ocular manifestation.Male to female ratio was 2:1 among HZO cases but ocular manifestation occurred more among males.Female with advanced age were involved more.Lid involvement(73.81%),conjunctivitis(69.05%),and keratitis(59.52%)were most common ocular manifestation followed by anterior uveitis(30.95%)and episcleritis(11.90%).Ocular hypertension(42.86%)was associated with almost every ocular manifestation.Among the cases of more than 45 years of age,9.52%patients acquired 6/6 vision compared to 7.14%patients at and below 45 years of age after 8wk of follow up.CONCLUSION:The visual outcomes are poor in HZO with advanced age group.Visual outcome of the affected eyes is poor than unaffected eyes.The loss of vision is mainly due to keratitis,anterior uveitis,posterior uveitis,and optic neuritis.

Complete recovery from segmental zoster paresis confirmed by magnetic resonance imaging:A case report

BACKGROUND Segmental zoster paresis,depending on the affected area,can present with severe clinical manifestations and render patients unable to perform activities of daily living.Therefore,it is necessary to diagnose and treat such a condition rapidly.No studies have reported using magnetic resonance imaging(MRI)to identify clinical abnormalities associated with this condition or its complete recovery.This rare case report evaluated the changes in MRI findings before and after the patient’s motor symptoms recovered.CASE SUMMARY A 79-year-old woman with a history of rheumatoid arthritis and psoriasis visited the hospital for skin rashes and pain in the C5-T2 segments.The diagnosis was herpes zoster infection,and treatment was initiated.However,motor weakness suddenly occurred 14 d after the initial symptom presentation.We confirmed abnormal findings in the nerves and muscles invaded by the shingles using electromyography and MRI.After 17 mo,the patient’s symptoms had completely normalized,and MRI confirmed that there were no abnormalities.CONCLUSION MRI can be a useful diagnostic modality for segmental zoster paresis and patient evaluation during recovery from motor complications.

Recurrent herpes zoster in a rheumatoid arthritis patient treated with tofacitinib: A case report and review of the literature

BACKGROUND Tofacitinib is an oral Janus kinase(JAK)inhibitor that is currently approved by the United States Food and Drug Administration for the treatment of rheumatoid arthritis(RA).Varicella zoster virus reactivation leading to herpes zoster(HZ)is an adverse effect of this drug;however,recurrent HZ at the same site is a rare clinical condition.CASE SUMMARY A 70-year-old female RA patient had undergone 1-year of tofacitinib treatment(10 mg daily).About 1 mo after initiation of oral tofacitinib,she developed blisters on the left flank and abdomen and was diagnosed with HZ;antiviral therapy with acyclovir was resolutory.However,5 d prior to presentation at our hospital,erythema and blisters with severe pain recurred at the same site.Small clustered blisters and bullous were visible on the left lumbar abdomen and perineum,with a pain score of 8(visual analogue scale).Antiviral,nutritional supplement,analgesic and other treatments led to healing but over an atypically long period(approximately 26 d,vs approximately 1 wk).HZ is a common and serious adverse reaction of JAK inhibitors,but it rarely recurs.Our patient’s experience of HZ recurrence at the same site,with a wider affected area,more severe pain and longer healing period,is inconsistent with previous reports.CONCLUSION Same-anatomical site HZ recurrence may occur during oral tofacitinib treatment,with more severe clinical manifestations than in the initial occurrence.

Meta-analysis and systematic evaluation of the curative effect and analgesic effect of acupuncture on herpes zoster

Objective:To systematically evaluate the clinical efficacy and analgesic effect of acupuncture and moxibustion in the treatment of herpes zoster by comparing western medicine.Methods:Randomized controlled trials on acupuncture and western medicine for herpes zoster were searched from CNKI,Wanfang Database,VIP,CMB,PubMed,Embase and Cochrane library databases,and the retrieval time was from January 2010 to July 2020.RevMan5.3 software was used for Meta analysis.Results:A total of 30 randomized controlled studies were included,involving a total of 4292 patients.Subgroup analysis was conducted according to different intervention measures in the experimental group.The results showed that:(1)The total effective rate of the subgroup analysis showed that the combined effect of acupuncture treatment alone RR=1.10,95%CI[1.05,1.15],P<0.0001.Results:RR=1.16,95%CI[0.86,1.57],P=0.33.It suggests that the therapeutic effect of acupuncture and moxibustion on herpes zoster is superior to that of western medicine,but acupuncture and western medicine treatment cannot improve the clinical efficacy of western medicine.However,due to the unstable meta-analysis of acupuncture and western medicine treatment in the subgroup,the results need to be treated with caution and further clinical verification is still needed.(2)VAS score improvement analysis showed that the combined effect of acupuncture alone RR=2.20,95%CI[1.53,2.87],P<0.00001.RR=1.12,95%CI[0.39,1.85],P=0.002,suggesting that acupuncture is significantly better than western medicine in improving the pain of shingles,and western medicine combined with acupuncture can improve the analgesic effect.(3)The subgroup analysis of sequelae incidence showed that the combined effect amount of acupuncture alone on sequelae incidence at 30 days was RR=0.34,95%CI[0.25,0.48],P<0.00001,and the combined effect amount of acupuncture combined with western medicine was RR=0.18,95%CI[0.05,0.69],P=0.01.Incidence of sequelae at 60 days RR=0.38,95%CI[0.23,0.62],P=0.0001;The incidence of post-herpetic neuralgia treated with acupuncture alone at 90 days RR=0.39,95%CI[0.20,0.74],P=0.004,suggesting that the incidence of post-herpetic neuralgia treated with acupuncture is significantly lower than that treated with western medicine,and western medicine combined with acupuncture can reduce the incidence of post-herpetic neuralgia.(4)The time analysis of the onset of pain relief showed that the combined effect of acupuncture alone RR=-2.32,95%CI[-2.48,-2.17],P<0.00001.RR=-2.39,95%CI[-2.70,-2.09],P<0.00001,suggesting that the onset time of acupuncture and moxibustion was shorter than that of western medicine,and western medicine combined with acupuncture and moxibustion could accelerate the onset time of analgesia.(5)The time analysis of pain relief showed that the combined effect of acupuncture alone RR=-10.80,95%CI[-12.49,-9.01],P<0.00001.RR=-5.98,95%CI[-11.55,-0.41],P=0.04,suggesting that acupuncture treatment of herpes zoster can significantly reduce the pain time,combined with western medicine can shorten the pain time.Conclusion:Acupuncture and moxibustion treatment of herpes zoster in the total effective rate,pain relief and the incidence of post-neurosis is significantly better than western medicine;Acupuncture and moxibustion combined with western medicine can improve the analgesic effect and reduce the incidence of post-neurosis.In view of the low overall quality of the literature included in this study,further clinical validation is needed for this conclusion.

Detection of Varicella Zoster Virus DNA within Lesions and Healed Skin Lesions of Herpes Zoster by PCR

Varicella zoster virus(VZV) DNA in blister lesions and skin biopsies obtained from healed skin lesions in 16 patients with herpes zoster was detected using polymerase chain reaction. A 385 bp VZV DNA fragment was found in all the blister lesions and in two of six biopsies from the skin lesions healed within two months by PCR. No VZV DNA was found in the skin lesions more than two months after healing in 10 cases of herpes zoster. VZV DNA may be detected at the sites of resolved herpes zoster lesions within short duration.

Herpes zoster in breast cancer：a case report

There is little information on herpes zoster infection in breast cancer patients as a complication during adjuvant chemotherapy.We report a case of herpes zoster in a 65-year-old woman presented with low grade fever and vital signs together with skin symptoms such as severe edema,irritation and itching in the left breast where there was wound drainage.PCR test revealed varicella zoster virus.To the best of our knowledge,the histologic features coupled with PCR led to a diagnosis of herpes zoster.

Herpes Zoster Ophthalmicus and Disseminated in an Immunocompetent Child

Herpes zoster and varicella are the two main clinical presentations of the varicella zoster virus infection. Varicella is the manifestation of primary infection. It is a systemic infection, frequent in childhood. Herpes zoster is a reactivation of the virus. It often occurs in immunocompromised situations such as AIDS. Several localizations can be observed in herpes zoster. Disseminated lesions are rarely described. Authors report a case of ophthalmic and generalized (or disseminated) herpes zoster in an immunocompetent child. No history of previous varicella and no particular medical background or family tare was found. However, maternal varicella when pregnant of our patient was reported. The patient had good nutritional status and no cause of immunosuppression. Immediate evolution was favorable for our patient, but the possibility of long-term complications of herpes zoster ophthalmicus should make consider the advisability of vaccination against varicella-zoster virus in children.

Efficacy comparison of different acupuncture methods for herpes zoster: a systematic review and Bayesian analysis

Objective:Acupuncture methods(including moxibustion)are used frequently in the treatment of herpes zoster.However,the choice is usually made only based on personal experience among different acupuncture methods.This study compared the effectiveness of different acupuncture methods for herpes zoster.Methods:All randomized controlled trials(RCTs)of acupuncture methods for herpes zoster were searched in seven databases including Cochrane Library,Embase,PubMed,Web of Science,Wan-fang,CNKI,and CQVIP database.After screening process,effectiveness rate was extracted from all the included RCTs as primary outcomes.The Bayesian network meta-analysis was conducted by GeMTC 0.14.3,Stata13.0 and Review Man 5.3.Results:39 studies were included,which contained 3,042 participants among 11 interventions.Based on the results of network meta-analysis and ranking probability,fire-acupuncture plus electro-acupuncture is considered to be the most effective method,followed by body-acupuncture plus moxibustion,fire-acupuncture,surround-acupuncture plus moxibustion,moxibustion,surround-acupuncture plus western medicine,surround-acupuncture plus electro-acupuncture,body-acupuncture plus western medicine,surround-acupuncture,western medicine,body-acupuncture.Global and local inconsistency test suggested no significant difference between the results of direct and indirect comparisons.Conclusion:Acupuncture methods might be an effective alternative treatment for herpes zoster and fire-acupuncture plus electro-acupuncture might be considered the best option among the included treatments.However,the results of this study need to be interpreted with caution,because there may still be a problem of small sample size of some studies and interventions.Future research,with a standard methodology and design,requires large-scale trials to validate the effect identified in this meta-analysis.

Odontogenic Herpes Zoster Infection: A Case Report and Review

Herpes zoster is a commonly encountered entity of which all clinicians should be aware. The diagnosis is most often considered and made based on a characteristic vesicular rash that presents in a unilateral dermatomal distribution and is usually accompanied by a painful neuritis. Not uncommonly, the pain presents a few days before the rash becomes evident and may even occur without the rash appearing. When this happens patients may be subject to further diagnostic testing seeking alternative diagnoses, as herpes zoster is known to mimic a variety of other non-cutaneous organ system entities. Although the thoracic and lumbar dermatomes are the affected most frequently, in approximately one-fifth of cases the cranial nerves are involved either singularly or in combination. Trigeminal nerve zoster is of particular concern as it poses a risk of developing into zoster ophthalmicus with subsequent keratitis and uveitis resulting in permanent vision impairment. Involvement of the second (maxillary) and third (mandibular) branches of this 5th cranial nerve are less common and may present with signs and symptoms of a primary dental process. The infrequency and unfamiliarity of herpes zoster odontogenic manifestations can lead to unnecessary investigation and treatment. Apropos such a case we review the epidemiology, pathophysiology, signs, and symptoms of odontogenic herpes zoster.