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Case Reports
. 2020 Sep;27(9):1748-1750.
doi: 10.1111/ene.14361.

COVID-19 and herpes zoster co-infection presenting with trigeminal neuropathy

A C A de F Ferreira  1 , T T Romão  1   2 , Y S Macedo  1   2 , C Pupe  1   2 , O J M Nascimento  2 ; Fellow of the American Academy of Neurology (FAAN)
Affiliations
Case Reports

COVID-19 and herpes zoster co-infection presenting with trigeminal neuropathy

A C A de F Ferreira et al. Eur J Neurol. 2020 Sep.

Abstract

Background: Varicella-zoster virus (VZV) is a human neurotropic virus that remains in a latent state within ganglionic neurons throughout the entire neuroaxis after the primary infection. When herpes zoster (HZ) leads to trigeminal involvement, the ophthalmic division is the most implicated. COVID-19 has emerged as a viral cause of severe acute respiratory syndrome that has spread all over the world in the last months. Co-infection with COVID-19 and other viruses has been reported, but sparsely, and involving the respiratory viruses.

Methods: The case of a co-infection of COVID-19 with VZV is reported, and the literature reviewed.

Results: A 39-year-old immunocompetent man presented with oligosymptomatic infection with COVID-19, which evolved to left facial HZ, affecting the three divisions of the trigeminal nerve. The co-infection was remotely registered, being the respiratory viruses, especially influenza, the most commonly cited association. However, the present case illustrates the emergence of a latent virus infection, which might be favored by the inflammatory response to the former agent (COVID-19). This reaction ascended from the nasal cavity, where trigeminal branches are also placed.

Conclusions: The emergence of latent VZV infection in this rare presentation might illustrate an effect, at least locally, of COVID-19. This virus possibly induced a retrograde reactivation of VZV in a young immunocompetent patient.

Keywords: COVID-19; co-infection; herpes zoster; trigeminal.

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Conflict of interest statement

The authors declare no financial or other conflicts of interest.

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