CASE REPORT

Herpes zoster opthalmicus in geriatric with malnutrition: a case report

Made Swastika Adiguna , Henny Wijaya, Made Detriasmita Saientisna

Made Swastika Adiguna
Department of Dermatology and Venereology, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia. Email: [email protected]

Henny Wijaya
Department of Dermatology and Venereology, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia

Made Detriasmita Saientisna
Department of Economic and Business, Faculty of Economic and Business Development Economy, Universitas Udayana, Bali, Indonesia
Online First: April 01, 2020 | Cite this Article
Adiguna, M., Wijaya, H., Saientisna, M. 2020. Herpes zoster opthalmicus in geriatric with malnutrition: a case report. Bali Medical Journal 9(1): 303-307. DOI:10.15562/bmj.v9i1.1641


Background: Herpes zoster opthalmicus (shingles) is a reactivation of latent Varicella Zoster Virus (VZV) affecting the ophthalmic branch of the trigeminal nerve. One of the risk factors that can cause reactivation of shingles are aging and immunosuppression conditions such as malnutrition.

Case: We reported a case of 75 years old patient with stabbing pain dan stinging sensation on the left forehead with a Visual Analog Scale (VAS) score of 3. Body mass index was calculated and showed underweight status (malnutrition). Dermatological examination showed erythematous, well-defined macules to patch, topped with a blackish-brown crust, with multiple erosions at some part over the left frontal region, superior palpebra and the parietal area (following the dermatome of the ophthalmic branch of the trigeminal nerve). The patient was given oral acyclovir, oral methylprednisolone, gabapentin, amitriptyline and vitamin B. The lesions were compressed with saline solution. The patient was also given high calories and protein intake to fix nutrition status. These interventions showed significant improvement of the lesions.

Discussion: The incidence and severity of shingles increases in geriatric patients. This can also be explained because aging is associated with a greater susceptibility of nutritional deficiency which can suppress specific and non-specific immunity. Nutritional conditions in herpes zoster patients can influence the severity and incidence of postherpetic neuralgia as well.

Conclusion: The purpose of reporting this case is to discuss nutritional status is an important factor that must be considered in dealing with the incidence of herpes zoster as to reduce the incidence of postherpetic neuralgia.

References

Schmader KE, Oxman MN. Varicella and Herpes Zoster. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: Mc Graw-Hills. 2012. p.2383-401.

Madkan V, Sra K, Brantley J, Carrasco D, Mendoza N, Tyring SK. In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. 2nd ed. Mosby: Elsevier. 2008.p.1204-08

Pusponegoro EHD. Herpes Zoster. Dalam: Djuanda A, Hamzah M, Aisah S, editors. Ilmu penyakit kulit dan kelamin. Edisi ketujuh. Jakarta: Fakultas Kedokteran Universitas Indonesia. 2011.H121-24.

Johnson BH, Palmer L, Gatwood J, Lenhart G, Kawai K, Acosta CJ. Annual incidence rates of herpes zoster among an immunocompetent population in the United States. BMC Infect Dis. 2015;15: 502.

Anonim. Buku Register Kunjungan Poliklinik Kulit dan Kelamin Rumah Sakit Umum Pusat Sanglah Denpasar. 2019.

Ting DSJ, Ghosh N, Ghosh S. herpes Zoster Opthalmicus. BMJ. Jan 2019;364:1-5

Werhahn MC, Dwyer DE. Herpes Zoster: Epidemiology, clinical features, treatment and prevention. Aust Prescr. 2012;35:143-7

Kawai K, Gebremeskel BG, Acosta CJ. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ. 2014;4(2):23-9.

Wareham DW, Breuer J. Herpes Zoster. BMJ. 2007; 334. p.1211-1215.

Sayhan MB, Sezenler E, Nalbur IH, Yagci G, Gezer E. Herpes Zoster Opthalmicus. JAEMCR. 2012; 3.p.74-76.

Fatmah. Respon Imunitas Yang Rendah Pada Tubuh Manusia Usia Lanjut. Makara : Kesehatan. 2006;10(1):47-53

Albiner Siagian. Gizi, Imunitas, Dan Penyakit Infeksi. Departemen Gizi dan Kesehatan Masyarakat FKM USU. 2013;12:188-194

Wollina U, Machetanz J. Herpes Zoster and Postherpetic Neuralgia. Hautarzt. 2016;67:653-65

Armando S, Nicoletta V, Sara P, Matilde G, Silvia L, Giovani G. Herpes zoster: New Preventive Perspective. Journal of Dermatology and Clinical Research. 2015; 3(1).1024-46.

Werner RN, Nikkels AF, Marinović B, Schäfer M, CzarneckaOperacz M, Agius AM, et al. European consensus-based guideline on the management of herpes zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 1: diagnosis. J Eur Acad Dermatol Venereol. 2017; 31: 9-19.

Mercado M, Kane S, Sagul A. Herpes Zoster and Postherpetic Neuralgia : Prevention and Management. AAFP. 2017;656-63

Dworkin RH, Johnson RW, Brever J, Gnann JW, Levin MJ. Recommendations for the Management of Herpes Zoster. Clinical Infectious Diseases Journal. 2007;44:21-26.

Vrcek I, Choudhury E, Durairaj V. Herpes Zoster Opthalmicus : a Review Of the Dermatologist. The Journal Medicine. 2017;130(1):21-26


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