Uncommon Yet Critical: A Pediatric Case Of Ophthalmic Herpes Zoster

While herpes zoster ophthalmicus (HZO) typically affects older adults and those with compromised immune systems,atypical presentations and complications may appear in children,including the immunocompetent ones. The aim of this report is to increase the  awareness of  healthcare professionals about pediatric herpes zoster ophthalmicus (HZO) through a clinical case study highlighting severe HZO in an immunocompetent child.

A 12-year-old girl without a worthy medical background , complained of visual loss in her right eye  10 days following a flu-like syndrome.

Her clinical examination showed a unilateral (OD) painful erythematous-vesicular lesion along the V1 nerve with infected crusts and a Hutchinson’s sign. VA  was at  01/10, with a diffuse conjunctival hyperemia, severe diffuse superficial punctate keratitis, and an areflexic semi-dilated pupil with grade III papillary edema and arteriovenous tortuosity.    

The patient had a biological evaluation that included a negative HIV serology, a complete blood count, and normal C-reactive protein (CRP) levels.

Her course of treatment included intravenous acyclovir (20 mg/kg/8H ), oral paracetamol 500 mg three times a day, and amoxicillin-clavulanic acid 1g three times a day for antimicrobial therapy. Ocular lavage twice daily, artificial tears eye drops four times a day, corneal healing ointment twice a day, and fusidic acid ointment applied to cutaneous lesions twice a day were among the topical treatments administered.Following five days, topical corticosteroid therapy was introduced, consisting of an ointment at night and three times a day of antibiotic-corticosteroid eye drops.

Short-term improvements were seen in palpebral edema, facial rash, and pain. Additionally, superficial punctate keratitis (SPK) showed improvement. However, visual acuity in the OD at 1/10 was unchanged. Forty days later, the patient's visual acuity improved to a 4/10, and three months later, it reached a 07/10 with a net regression of papilloedema.

Herpes zoster ophthalmicus (HZO) is a rare but potentially serious condition caused by the reactivation of the varicella-zoster virus (VZV) within the ophthalmic division of the trigeminal nerve. Although HZO is more frequently seen in adults, pediatric occurrences are rarer. However, HZO has been documented in this age group with a variety of symptoms. Reducing systemic and ocular morbidity requires better understanding of this curable disease .