Herpes Zoster Mandibularis
A 70-year-old man presented with a 2-day history of facial edema, rash with vesicles, pustules, and crusts along the left lower jaw, and plaque that had covered the anterior two thirds of the left half of his tongue. He reported that he had had pain in the lower half of the left side of his face, otalgia, and glossodynia for 3 days before the outbreak of the rash. On examination, there were no neurologic deficits, meningeal signs, or lymphadenopathy. The lesions were scattered along the area that is innervated by the third division of the trigeminal nerve. A presumptive diagnosis of herpes zoster mandibularis was made. Given the particular distribution of the rash, herpes simplex virus or enterovirus infection was considered to be less likely. The patient underwent empirical treatment with acyclovir, analgesic agents (including gabapentin), nystatin, and an antibiotic agent for bacterial superinfection. One month after the resolution of the facial rash, postherpetic neuralgia developed along the involved dermatome. The patient had moderately intense pain for approximately 4 months after resolution of the rash, after which time the pain subsided. At a follow-up visit 6 months after the resolution of the rash, he was asymptomatic and had stopped taking gabapentin.
