Herpes zoster ophthalmicus in a healthy child

Description

A previously healthy 6-year-old male child presented in the emergency department with a 4-day history of painless erythematous-papulomacular rash that started on the left side of the forehead. The lesions became blistered and confluent, spreading to the nasal bridge and upper and lower eye lids sparing the tip of the nose (figure 1A).

Figure 1.

Herpes zoster involving the ophthalmic branch of the left trigeminal nerve (A). Resolution 20 days after treatment (B).

Varicella vaccine was given at 1 year age and his mother denied any eruptive disease during pregnancy. PCR and Tzanck test confirmed the clinical suspicion of herpes zoster. Oral acyclovir was given for 14 days with excellent results (figure 1B). No ophthalmological complications were present during convalescence time.

Herpes zoster ophthalmicus in children is uncommon and is only barely described in the literature especially in immunosuppressed children.¹ Nasociliary branch involvement known as Hutchinson's sign is considered a prognostic sign of sight-threatening ocular complications and is clinically manifested by the skin involvement of the tip of the nose.²

Learning points.

• Varicella zoster is very rare in healthy children.

• Its presentation is less severe and usually with less sequela than in adults.

• Nasociliary branch involvement is known as Hutchinson’s sign as is recognised when the tip of the nose is affected.