Herpes zoster ophthalmicus with ocular involvement in overtreated hyperthyroidism

Abstract

A 25-year-old man, with a history of hyperthyroidism presented with herpes zoster ophthalmicus (HZO) with neurotrophic ulcer and superadded infection 4 weeks after a sudden decrease in his thyroid hormones, caused by overtreatment of hyperthyroidism and radioactive iodine therapy. He underwent lateral tarsorrhaphy and was started on conservative treatment for the ulcer. The ulcer had resolved after 2 months. HZO is caused by reactivation of varicella-zoster virus by a decline in cell-mediated immunity. The decrease in thyroid hormones can also reactivate varicella-zoster by immunosuppression. This case highlights the importance of stability in thyroid hormones in a patient with thyroid disease and history of varicella.

Keywords: Herpes zoster ophthalmicus; herpes zoster in thyroid disease; reactivation of herpes zoster.

Figure 1

Photograph of the face showing multiple blisters on the right side of the forehead, respecting the midline, with ipsilateral upper lid edema and crusting; suggestive of herpes zoster ophthalmicus

Figure 2

Anterior segment photograph of the right eye showing diffuse conjunctival congestion with a neurotrophic ulcer with full-thickness corneal infiltrates in the inferior half of eye