acyclovir and Osteonecrosis

Osteonecrosis following herpes zoster infection is a rare but severe complication, and clinicians' awareness is important for early detection and management of this condition. A case of herpes zoster of the left maxillary division of the trigeminal nerve is reported in a young female having no concurrent predisposing factors, with accompanying rare complications of alveolar bone necrosis and rapid tooth exfoliation. Acyclovir was used to manage the case effectively. The previously reported similar cases in the literature have been reviewed and the pathophysiology of tooth exfoliation and osteonecrosis by varicella zoster viruses is discussed.

Topics: Acyclovir; Adult; Antiviral Agents; Cicatrix; Cranial Nerve Diseases; Facial Dermatoses; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Maxillary Diseases; Maxillary Nerve; Osteonecrosis; Tooth Loss; Virus Activation

Herpes zoster (HZ) presents as a cutaneous vesicular eruption in the area innervated by the affected sensory nerve, usually associated with severe pain. Oral manifestations of HZ appear when the mandibular or maxillary divisions of the trigeminal nerve are affected.. This is a case report of a 63-year-old woman with HZ infection with trigeminal nerve involvement that led to a rapid loss of alveolar bone and exfoliation of two teeth.. The initial intraoral examination showed redness of the alveolar mucosa and gingiva of the lower right quadrant with multiple well-delimited and painful erosive lesions affecting the attached gingiva around the teeth. Two weeks later, teeth number 27 (lower right canine) and 28 (lower right first premolar) had class III mobility, flow of purulent exudate from the gingival sulcus, and deep pockets (>11 mm). The radiological examination showed advanced alveolar bone loss around both teeth. The prognosis for teeth number 27 and 28 was considered hopeless, and they were extracted. Due to extensive necrosis there was no interdental alveolar bone. The case is presented with a review of clinical data from patients with trigeminal HZ infection associated with osteonecrosis or exfoliation of teeth previously reported in the literature. The mechanisms by which the HZ infection leads to the alveolar bone necrosis are discussed.. Extensive osteonecrosis and exfoliation of teeth in the area innervated by the nerve affected by HZ has been reported after HZ infection. Clinicians should be aware of this possible outcome after a trigeminal HZ infection.

Topics: Acyclovir; Alveolar Bone Loss; Antiviral Agents; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Mandibular Diseases; Middle Aged; Osteonecrosis; Tooth Exfoliation; Trigeminal Nerve

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Exanthema; Facial Dermatoses; Floxacillin; Gingival Diseases; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Maxillary Diseases; Middle Aged; Mouth Mucosa; Osteonecrosis; Penicillin G; Virus Activation

This paper presents a case of HIV-associated fulminating herpes zoster infection (HZI) that culminated in right mandibular necrosis and tooth exfoliation. The occurrence of such infection in immunosuppression and the impending clinical features are briefly reviewed and discussed.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Alveolar Bone Loss; Antiviral Agents; Herpes Zoster; Humans; Male; Mandibular Diseases; Osteonecrosis; Tooth Loss