Herpes-zoster virus ophthalmicus as presenting sign of HIV disease

Abstract

After a childhood episode of chicken pox, a Varicella-Zoster infection, the viral DNA reside in a dormant state in the dorsal root ganglia. The viruses get reactivated when the individual is immuno-compromised, in adulthood to cause characteristic lesions of Herpes zoster on the skin and the eyes. This case reports a 32 year old female who presented with neuralgia and clinical features of crusting skin ulcers involving the ophthalmic division of the trigeminal nerve, corneal dendritis and anterior uveitis with circumlimbal injection of the right eye. Visual acuity was OD: 6/60 and 0S:6/9. These clinical signs and symptoms were consistent with Herpes Zoster Ophthalmicus (HZO). Further medical laboratory tests showed positive for HIV and patient had a CD4+ count of 350 cells/μl of blood with a viral load of 100,000 copies/μl. Patient was subsequently treated of the Herpes zoster infection with Acyclovir (800 mg) prescribed five times daily for 7 days. While, at the HIV/AIDS project facility she was placed on Hyper Active Antiretroviral therapy (HAART): Stavudine (30 mg) bid for 2/12, Zidovudine (300 mg) bid for 2/12 and Efavirenz (600mg) nocte for 2/12. There was complete resolution of the keratopathy, the visual acuity of OD improved to 6/12 by the 2nd month and the patient was without the experience of post herpetic neuralgia. At present (after 3 months) her CD4+ has increased to 1000 cells/μl. HIV infection should always be considered in patients younger than 65 years with Herpes zoster ophthalmicus.

Keywords

• Chicken-pox
• Herpes zoster
• Varicella-Zoster
• Opportunistic infection
• HZO
• Anti-viral
• HIV/AIDS