Anesth Pain Med.  2020 Apr;15(2):205-208. 10.17085/apm.2020.15.2.205.

Herpes zoster in the ophthalmic branch of the trigeminal ganglia obscuring cavernous sinus thrombosis due to Streptococcus constellatus ssp. constellatus

• Lee JH
• Heo HJ
• Kim KM
• Lee HG
• Baek SM
• Jung DW

• KMID: 2500973
• DOI: http://doi.org/10.17085/apm.2020.15.2.205

Abstract

Background
Herpes zoster ophthalmicus (HZO) is an infectious disease that results from the reactivation of latent varicella zoster virus in the ophthalmic branch of the trigeminal ganglia. HZO manifests with herpes zoster-like symptoms such as rash with or without signs of ocular involvement. Cavernous sinus thrombosis (CST) is a life-threatening condition accompanied by signs and symptoms involving the eyes and the cranial nerves. Case: We report a case of septic cavernous sinus thrombosis (caused by Streptococcus constellatus ssp. constellatus) which was masked by the simultaneous occurrence of HZO in this patient, resulting in delayed diagnosis. Conclusions: CST may be obscured by HZO, prompt diagnosis and treatment is necessary when such case arrive.

Keyword

Cavernous sinus thrombosis; Herpes zoster opthalmicuss; Streptococcus constellatus

Figure

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  Fig. 1. Both superior ophthalmic veins presenting with engorgement and thrombus in the posterior region (A: axial, B: coronal view).

Reference

1. Ragozzino MW, Melton LJ 3rd, Kurland LT, Chu CP, Perry HO. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore). 1982; 61:310–6.

2. Johnson JL, Amzat R, Martin N. Herpes zoster ophthalmicus. Prim Care. 2015; 42:285–303.

3. Coutinho JM. Cerebral venous thrombosis. J Thromb Haemost. 2015; 13 Suppl 1:S238–44.

4. Einhäupl K, Stam J, Bousser MG, De Bruijn SF, Ferro JM, Martinelli I, European Federation of Neurological Societies, et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol. 2010; 17:1229–35.

5. Lai PF, Cusimano MD. The spectrum of cavernous sinus and orbital venous thrombosis: a case and a review. Skull Base Surg. 1996; 6:53–9.

6. Weerasinghe D, Lueck CJ. Septic cavernous sinus thrombosis: case report and review of the literature. Neuroophthalmology. 2016; 40:263–76.

7. Siddiqi SA, Nishat S, Kanwar D, Ali F, Azeemuddin M, Wasay M. Cerebral venous sinus thrombosis: association with primary varicella zoster virus infection. J Stroke Cerebrovasc Dis. 2012; 21:917. e1-4.

8. Paul G, Paul BS, Singh G. Unseen face of varicella-zoster infection in adults. Indian J Crit Care Med. 2016; 20:731–4.

9. Khan R, Yasmeen A, Pandey AK, Al Saffar K, Narayanan SR. Cerebral venous thrombosis and acute pulmonary embolism following varicella infection. Eur J Case Rep Intern Med. 2019; 6:001171.

10. Nagel MA, Jones D, Wyborny A. Varicella zoster virus vasculopathy: the expanding clinical spectrum and pathogenesis. J Neuroimmunol. 2017; 308:112–7.