Delayed Superior Orbital Fissure Syndrome Arising More than One Month after Herpes Zoster Ophthalmicus and Meningitis

A 79-year-old woman developed herpes zoster ophthalmicus (HZO) with a vesicular rash on the nasal root, which developed soon after intravenous acyclovir therapy. Although varicella zoster virus DNA was undetectable in the cerebrospinal fluid, she presented with ophthalmoplegia without optic nerve dy...

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Bibliographic Details
Published in:Internal Medicine 2024, pp.3652-24
Main Authors: Takahashi, Sunao, Okabayashi, Kotaro, Soejima, Itsuki, Oniki, Ayako, Ishihara, Shoichiro, Tomimitsu, Hiroyuki
Format: Article
Language:English
Subjects:
herpes zoster ophthalmicus
meningitis
multiple cranial neuropathies
superior orbital fissure syndrome
varicella zoster virus
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Summary:A 79-year-old woman developed herpes zoster ophthalmicus (HZO) with a vesicular rash on the nasal root, which developed soon after intravenous acyclovir therapy. Although varicella zoster virus DNA was undetectable in the cerebrospinal fluid, she presented with ophthalmoplegia without optic nerve dysfunction 32 days after the onset of HZO. We diagnosed the patient with superior orbital fissure syndrome and administered intravenous immunoglobulin and systemic corticosteroids. Ophthalmoplegia did not immediately respond to these therapies but resolved 4 months later. We should be aware that ophthalmoplegia can occur, even after HZO and meningitis are completely treated.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.3652-24