Ophthalmic Herpes Zoster in an immunocompromised patient

Abstract

Objective 

To report the case of an immunocompromised female patient who developed ophthalmic herpes zoster, requiring intravenous management due to dermatological and neuro ophthalmological involvement, with partial recovery following treatment.

Case Report 

A 60-year-old female patient was admitted for severe malnutrition and chronic diarrheal syndrome, presenting with cachexia and electrolyte imbalance. Her medical history includes celiac disease, dilated cardiomyopathy, and pancreatitis, for which she was being treated with systemic corticosteroids (Methylprednisolone 40 mg/day). During hospitalization, she developed left eye pain and bilateral eyelid edema, leading to a diagnosis of herpes zoster ophthalmicus. Antiviral treatment was initiated with oral Acyclovir 800 mg every 6 hours, along with ophthalmic ganciclovir ointment. Due to a lack of improvement, intravenous antiviral therapy (Acyclovir 500 mg/8 hours) and antibiotic therapy (Ceftriaxone 2 g/24 hours + Clindamycin 600 mg/8 hours) were administered. After discharge, the patient developed trigeminal neuralgia and ophthalmoplegia, necessitating further management. Magnetic resonance imaging revealed inflammation of the optic nerve and adjacent structures. Although the patient declined a biopsy of the cerebral inflammatory lesion, she showed symptomatic improvement. She continued to experience photophobia and an inability to abduct the eye, with reduced visual acuity. Topical treatment and visual correction were established, and regular follow-ups were scheduled.

Conclusion 

Managing ophthalmic herpes zoster in immunocompromised patients with severe malnutrition and comorbidities requires a multidisciplinary approach and intensive treatment. Despite antiviral and antibiotic therapy, neurological complications may persist, emphasizing the need for continuous monitoring and personalized care.