acyclovir and Hoarseness

Herpes zoster is a neurocutaneous disease resulting from the reactivation of endogenous varicella-zoster virus (VZV) in dorsal sensory or cranial nerve ganglia. Rarely, this infection manifests without the characteristic dermatomal rash, a condition termed zoster sine herpete. Viral spreading of herpes zoster in the head and neck may manifest as various signs and symptoms because of the multiple possible combinations of cranial neuropathies. With only six cases reported in the English literature up to now, isolated neuropathies of the vagus nerve in the absence of cutaneous lesions tend to be misdiagnosed as idiopathic laryngeal paralysis.. We report a case of herpes zoster of the larynx in an 80-year-old man presenting with sore throat, dysphagia, and hoarseness.. Endoscopic examination revealed unilateral vocal fold paralysis, pooling of secretions, and mucosal vesicles of the hemilarynx. After the diagnosis of VZV infection with polymerase chain reaction (PCR) testing, the patient was treated with valacyclovir and corticosteroids, leading to complete recovery after 2 months.. Herpes zoster of the larynx is an uncommon condition that should be included in the differential diagnosis of laryngeal paralysis of idiopathic cause. We recommend performing a thorough examination of the pharyngolaryngeal structures and ordering PCR testing as the diagnostic method of choice.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Deglutition Disorders; Herpes Zoster; Herpesvirus 3, Human; Hoarseness; Humans; Laryngoscopy; Male; Pharyngitis; Polymerase Chain Reaction; Predictive Value of Tests; Remission Induction; Steroids; Time Factors; Treatment Outcome; Valacyclovir; Valine; Virus Activation; Vocal Cord Paralysis

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Colitis; Cranial Nerve Diseases; Cytomegalovirus Infections; Ganciclovir; Hoarseness; Humans; Laryngeal Nerves; Male; Opportunistic Infections; Recurrent Laryngeal Nerve; Vocal Cord Paralysis

This report describes a newborn with recurrent herpes simplex meningoencephalitis despite vigorous antiviral therapy. The course is unusual in that the presenting symptom was hoarseness. Despite probable adequate acyclovir levels in the spinal fluid, a second episode or progression of herpetic encephalitis occurred, suggesting impairment of host defenses, particularly cellular immunity. This episode was treated with both acyclovir and vidarabine. Pharmacokinetics of the antiviral therapy and immune responses are discussed.

Topics: Acyclovir; Herpes Simplex; Hoarseness; Humans; Infant, Newborn; Male; Meningoencephalitis; Recurrence; Vidarabine