Pregabalin

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

A 39-year-old man exhibited lack of efficacy during treatment with pregabalin for left trigeminal neuralgia.

The man, who had a history of chickenpox during childhood, experienced fatigability and occasional episodes of diarrhoea, followed by left trigeminal neuralgia. He had no history of use of immunosuppressive drugs. On 22 March 2020 (three days after the neuralgia started), he developed low fever episodes. Consequently, he presented to emergency room. No cutaneous lesion was noted and was discharged with symptomatic drugs. However, later during the same day, he developed a papulovesicular rash. He received a prescription for pregabalin [dosage and route not stated] and aciclovir. However, no improvement in his condition was noted (lack of efficacy with pregabalin). On 25 March 2020, he was admitted due to left orofacial herpes zoster involving the left three trigeminal divisions. Intraoral mucosal lesions were also noted. He had sharp left hemifacial pain, especially during chewing, and hypogeusia for sweetness. He also had photosensitivity. Laboratory tests revealed Varicella-zoster IgM serology positive. A brain MRI showed left trigeminal nerve enhancement. He started receiving treatment with aciclovir, and improvement in his condition was noted within 24h. On day 5, the progression of herpes zoster lesions stopped, and he had no fever or respiratory symptoms. Later, he reported that he travelled to Brazil form UAE via cruise and arrived in Brazil on 7 March 2020. He also met his friend on 14 March 2020, who came from USA. Due to the travel and contact history provided by him, he was tested for COVID-19 by RT-PCR of nasopharyngeal swab, which showed positive result. It was thought that the COVID-19 infection caused reactivation of latent Varicella-zoster virus infection.