An Atypical Ocular Presentation in Varicella Zoster Virus Meningoencephalitis: A Case Report
Thamarai Munirathinam *
Department of Ophthalmology, Hospital Enche’ Besar Hajjah Khalsom, Kluang, Malaysia.
Peng Li Jing
Department of Ophthalmology, Hospital Enche’ Besar Hajjah Khalsom, Kluang, Malaysia.
*Author to whom correspondence should be addressed.
Abstract
Background: To report a rare case of herpes zoster ophthalmicus with atypical vesicular rash complicated with abducens nerve palsy and retinitis.
Case Report: A 17 years old girl presented with fever, headache and neck pain associated with a scattered vesicular rash over the trunk and the bilateral temporal region. Left abducens nerve palsy was noted with retinitis changes over the right eye. Cerebrospinal fluid analysis was positive for varicella zoster virus IgG. Contrast enhanced computed tomography of brain and orbit was normal. The abducens nerve palsy and retinitis resolved with 3 weeks of systemic antiviral therapy.
Conclusion: Herpes zoster infection should be suspected in patients presenting with diplopia and rashes on the face. The fundus should be examined thoroughly to identify peripheral retinitis. Systemic examination and laboratory investigations are essential for establishing the diagnosis. Ophthalmoplegia can occur as a complication of varicella zoster infection and shows a favourable prognosis with systemic antiviral treatment.
Keywords: Herpes zoster ophthalmicus, diplopia, abducens nerve, antiviral, retinitis