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

• Published in: European journal of neurology Vol. 27; no. 9; pp. 1748 - 1750
• Main Authors: Ferreira, A. C. A. de F., Romão, T. T., Macedo, Y. S., Pupe, C., Nascimento, O. J. M.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.09.2020; John Wiley and Sons Inc
• Subjects: Activation; Adult; Case Study; Coinfection; COVID-19; COVID-19 - complications; co‐infection; Herpes zoster; Herpes Zoster - complications; Humans; Infections; Inflammation; Inflammatory response; Influenza; Male; Neuropathies; Neuropathy; Nose; Respiratory diseases; Severe acute respiratory syndrome; trigeminal; Trigeminal nerve; Trigeminal Nerve Diseases - etiology; Varicella; Viral diseases; Viruses; COVID-19; herpes zoster; co-infection; trigeminal
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.14361

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.