Shingles

Case 1 A 56-year-old woman with advanced lymphoma presented with numerous coalescing lesions confined to the distributions of the left maxillary and ophthalmic divisions of the fifth cranial nerve. Ulcerations were also apparent on the left hemipalate. She had completed radiotherapy months before, but she continued to receive aggressive, multidrug chemotherapy, with the last course within days of the onset of the rash. Lesions were culture positive for varicella-zoster virus (VZV). Treatment was begun with high-dose intravenous acyclovir and continued for 7 days until new vesicles stopped forming. Nonetheless, existing lesions evolved into a confluent eschar (Fig 1, left). She then experienced an episode of mental confusion and right-sided paresis presumed to be secondary to virus-associated granulomatous angiitis of the left middle cerebral artery. Then all the teeth in her left maxillary arch loosened and were lost. Left maxillary sinusitis developed, necessitating antibiotics and surgical creation of a