Журнал клинических случаев

Herpes Zoster Ophtalmicus in an Immunocompetent Child as Primary Presentation

Abstract

Er-Rachiq Issam, Boubsir Rajaa, Jatik badr, Mchachi Adil, Benhmidoune Laila, Chakib Abderrahim, Rachid Rayad, Elbelhadji Mohamed, Nassid meryem, Amnezoui Naima and Bousfiha Ahmed Aziz

Aim & Purpose: To report a new case of herpes zoster in an immunocompetent pediatric patient. Case report: A previously healthy 6-year-old boy which the medical history revealed no anterior vaccination against VZV but a maternal varicella during the pregnancy. He Consults on our Emergency Department for a diffuse vesicular skin eruption, particularly covering the left forehead, a blurry vision, photophobia and a left-sided Headache. The clinical examination revealed a sub-febrile temperature (38.5°C), a thick layer of necrotizing crusts covering the left forehead, a upper eyelid, vesicles and pustules with an erythematous base on the left zygoma extending to the left lateral canthus, a bilateral eyelid edema particularly on the left and the Hutchinson's sign, a predictor of ocular inflammation and corneal sensory denervation, was present. The best visual Acuity was 10/10 in the right eye and 7/10 on the left. The slit lamp examination noted in left eye a conjunctival hyperemia with a pseudo dendritic epithelial keratitis, a diffuse fluorescein staining of the corneal epithelium, and secretions. The right eye was normal. The laboratory investigations revealed white blood cells at 5.1 × 103 cells/μL, the basic immunological tests (Immunoglobulines; C3 and C4 levels) were normal and the HIV serology was negative. A clinical diagnosis of herpes zoster was made, and the patient was started on intravenous Acyclovir (10 mg/kg/dose every 8 hours) associated to topical Gancyclovir, eye wash solution, topical antibiotic, lubricating eye drops and Dermatologic ointments daily for 1 week. The evolution was marked by a complete remission without sequelea. Discussion and Conclusion: The peculiarity of our observation is the occurrence of shingles in an immunocompetent child, without notion of previous chickenpox and the ophthalmic localization which remains a rare form in children. Clinicians must be vigilant in their evaluation of vesicular lesions in children even without known varicella exposure.