A little-known relationship between immune recovery syndrome and herpes zoster

Abstract

Following anti-retroviral therapy (ART) or highly active antiretroviral therapy, there is an increased response to latent infections such as herpes zoster, which may lead to their reactivation. This is a result of improved immunity brought about by ART, also termed immune recovery syndrome. A 75-year-old male patient arrived at our institute with widespread vesicles and scabs on the right half of his face and oral cavity, suggesting the involvement of the trigeminal nerve. The patient had a history of being on ART two months earlier and a history of tooth extraction eight days prior to his arrival at our institute. The incidence of human immunodeficiency virus (HIV)-positive cases amongst herpes zoster cases is high, and these patients become susceptible to infections following ART. Therefore, regardless of the presence of risk factors, every herpes zoster patient should be tested for HIV infection, and high anti-retroviral therapy should be commenced/reinstituted as soon as possible. In addition, the treating physician should maintain a high level of vigilance for the patient during the first few months of ART, the peak incidence of immune recovery inflammatory disease.

Trigeminal Herpes Zoster: Case Report

“…In addition to age, people in an immunosuppressive state, such as bone marrow transplant recipients and HIV-positive patients are also at risk 2,5,10 . Some authors recommend that, regardless of the concomitant presence of other risk factors, all patients with herpes zoster should be tested for HIV 3 .…”

“…In the first, symptoms such as pain, tingling and itching of the skin, on the distribution of the affected nerve, usually precede the rash, present in the active stage, for a few hours or several days 2 . During this period, if the branches of the trigeminal nerve are affected, tooth pain and pulp necrosis may occur, with significant diagnostic difficulties 3,4,7 . HZ should always be considered in the differential diagnosis of patients with atypical tooth pain 4 .…”

“…HZ is generally a self-limiting condition, with complete resolution, and its treatment is indicated to reduce acute symptoms of pain and malaise, limit the spread and duration of skin lesions and prevent complications. Antiviral therapy is recommended, with acyclovir (800 mg orally 5 times daily for 10 days) or famiclovir (500 mg orally 3 times daily for 7 days) or valacyclovir (1000 g orally 3 times daily) day for 7 days), within 72 hours after the onset of symptoms 3,5,9 .…”

“…Varicella-zoster (VZV) is a virus that belongs to the Herpesvirus family, which can cause two different clinical infections: a primary infection, varicella and secondary or recurrent, or herpes zoster (HZ) 1,2 . After chickenpox is resolved, the virus remains latent in the dorsal root ganglia, and may, at some point, reactivate and trigger herpes zoster [2][3][4] .…”

Periocular dermatoses

“…An Indian study reported that 37.7% of cases with HZ also had HIV. HIV testing is suggested for patients younger than 50 years of age or those who present with more than one dermatomal involvement ( Bhandage et al, 2016 ).…”