UMEM Educational Pearls

Title: What's the Diagnosis? Written by Zachary Dezman

Category: Visual Diagnosis

Posted: 9/17/2012 by Haney Mallemat, MD
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27 year-old woman with AIDS presents complaining of a painful, puritic, and papular rash. What's the diagnosis?

Answer: Herpes zoster ophthalmicus

Herpes Zoster Ophthalmicus

Zoster involving the ophthalmic branch (V1) of the trigeminal nerve
Concomitant nasal rash is called Hutchinson's sign and heralds involvement of the eye (specifically the cornea); the nasociliary nerve innervates both the nose and eye
Must perform a thorough evaluation of the eye including slit lamp and fluorescein
Consider admission if:
- symptoms are severe
- 2 or more dermatomes are involved
- patients are immunocomprosmised
Treatment is with acyclovir, valacyclovir, or famciclovir

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