Poster
# 117
Poster |
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6th Internet World Congress for Biomedical Sciences |
Alejandro Nogueira(1), Olatz Alcelay(2), MŞ Jesús Martínez González(3), Teresa Pérez (4)
(1)(2)(3)(4)Hospital Central de Asturias - Oviedo. Spain
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 [Infectious Diseases] |
[Ophthalmology] |
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[Plastic Surgery] |
Herpes zoster ophtalmicus is a disease in which Varicela -Zoster virus reproduces and causes an inflammatory proccess of ophtalmic-trigeminal facial skin, and occasionally other divisions of this nerve. It may be associated with conjunctivitis, queratitis, uveitis. extrinsic ocular muscular paralysis and acute retinal necrosis. Orbitary complications are usually produced between one or two weeks after cutaneous eruption, healing slowly with or without treatment. Central nervous sistem afection is sometimes produced, specially in inmunodepressed, as intracraneal extension of hystologic proccess of granulomatous vasculitis. Cutaneous hystology is an sterile vasculitis and granulomatous liponecrosis, and other divisions of V pair craneal may be affected. Gingivitis, odontalgy, auditives diseases, neuralgias and muscular palsy often coexist. Vasculitis produces ocasionally cutaneous, osseous or alveolar necrosis, that results in cutaneous and teeth loss and fistulae. Delayed arteritis temporal artery as a complication of herpes zoster ophtalmicus is an extremely uncommon proccess, in which is not possible to demostrate viral particles by electron microscopy. It is considered a consequence of the proximity extension of the granulomatous vasculitis to the carotid system, not a direct viral invasion (3).
Case 1: 78 year-old, male, with antecedent of previous left senile catharat, presents right trigeminal herpes zoster affecting ophtalmic and maxilar-trigeminal facial skin. Cutaneous procces is extended to the right orbicular and malar zone presenting alveolar inflamation of upper right maxila without teeth loss. It´s resoluted in 15 days.
At 8th day the patient suffers blindness of right eye during 5 days that heals without treatment. One month later he develops nacrotic plaque, 15x10 cm, on right temporal and bilateral parieto-frontal area. Ophtalmic and radiologic studies are normal. Right carotid arteriography results in stenosis of 50% at the external carotid origin, stop at exit of internal maxilar and superficial temporal artery thrombosis. Likewise rich colateral circulation is developed. Lumen of internal carotid artery presents abundant irregularities with very thin wall of ophtalmic division. Superficial temporal artery biopsy presents trombosed with fibroconnective tissue inside, intimate is thick and muscular presents focal inflammatory infiltration without giant cells does not extend to other level.
It´s debrided necrosis plaque, exposing periosteal loss bone. It´s removed external table and is applied split thickness skin grafts that took partiallity. It´s neccesary two times more for ostectomyes and split thickness skin grafts again until reepitelitation completely. Not cantral neurologic complication appears.
Case 2: 67 year-old, male, at cronic corticosteroid treatment, debuts with left ophtalmic herpes, acute retinian necrosis, oculomotor palsy, queratitis and blidness, simultaneous un days. Antiviral treatment is given. The following month he developed headache, right hemiplegy, level conscience decreased and heé taken to intensive care unit. At that moment he presented left scalp necrosis that after debridement, frontal lobe is exposed in 10x8 cm area. Arteriography proves superficial temporal and central retinal artery thrombosis. There were irregularities at left intracraneal vessels with multiples aneurismatic changes and hemorrhagic at internal carotid system.
The patient suffers neurologic damage progresively until death 6 weeks later.
Figure 1: Pre y post-op aspect in case 1. Favourable evolution.
Figure 2: Aspect in case 2. Necrosis area is larger than case 1. Evolution is to exitus for multiple complications
Herpes zoster ophtalmicus is less frecuent than thoracolumbar localization and tends to cause more severe and rare complications.Cautaneous necrosis in herpes zoster ophtalmicus is dued to vasculitis. Necrosis by delayed arteritis of temporal artery is uncommon but in both cases presented it appears and produces extensive lesions that in case 2, inmunodepressed, had affected to central nervous system and caused death to the patient. Evolution of this pathology is independent of antiviral drugs, although these decreased the simptoms and period of illness. In our cases the evolution didn´t improve with antiviral treatment (1), ( 2).
Associated lessions with herpes zoster infection of trigeminal nerve are rare, but origins severe complications, even sometimes with evolution at death, more frecuently in patients inmunodepressed or carriers of malignant tumours. Necrosis produced will be debrided and reconstructed in each case.
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[Infectious Diseases] |
[Ophthalmology] |
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[Plastic Surgery] |
