32 year-old male presents with the following. What's the diagnosis?
Answer
Answer: Hutchinson's Sign
Herpes zoster ophthalmicus (HZO)
HZO occurs when varicella-zoster, becomes reactivated in the ophthalmic division (V1) of the trigeminal nerve; any of the V1 branches may be affected (supraorbital, lacrimal, and nasociliary branches); nasocilliary innervates the globe.
Most patients develop only a periorbital rash, but a minority of patients have corneal involvement; the risk is increased in immunocompromised patients.
Hutchinson’s sign is when the rash occurs at the tip of the nose; patients with the sign have twice the incidence of ocular involvement, but 33% with HZO do not develop the sign.
Corneal involvement can result in significant visual complications and vision loss. Slit lamp exam with fluorescein is required when corneal involvement is suspected; a dendritic pattern may be seen.
Patients with eye involvement should be referred for urgent ophthalmologic evaluation following initiation of antiviral medications.
References
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