Life-threatening orofacial herpes zoster infection affecting the maxillary and mandibular branches of the trigeminal nerve: A case report

Herpes zoster infection is often associated with cutaneous, visceral, and neurological complications. The risk of complications is high in specific populations, such as the elderly, immunodeficient individuals, and people receiving immunosuppressive therapy. Herpes zoster infection affecting the cranial nerves, particularly the trigeminal nerve, may lead to severe conditions, such as postherpetic neuralgia, encephalitis, vision loss, airway obstruction, and disabilities, if unrecognized and inadequately treated. A fully conscious 70-year-old man presented with painful vesicular eruptions and yellow crusts along his left cheek, jaw, and lower lip. Furthermore, shallow ulcers covered the left half of his tongue and abruptly stopped to appear at the midline. The patient was diagnosed with herpes zoster infection of the orofacial region and was treated with intravenous acyclovir, gabapentin, and paracetamol and topical sodium fucidate ointment following the application of wet-todry gauze dressing using normal saline solution. On the second day of admission, the patient became unconscious; subsequently, respiratory failure developed. Nasopharyngolaryngoscopy examination revealed edema of the epiglottis and laryngeal mucosa with mucus hypersecretion; thus, he was intubated. Laboratory workup showed high procalcitonin (20.16ng/mL) levels and leukocytosis (10.86 × 10⁹ cells/L) levels; therefore, methylprednisolone and meropenem were added to his treatment regimen. The patient was closely monitored in the intensive care unit and was provided with definitive airway management via intubation; after 11th day of admission, his condition improved and edema of the airway subsided.