UMEM Educational Pearls


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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