Herpes Zoster Infection in an Immunocompromised Patient: A Case Report and Review of Corticosteroid’s Role

Herpes zoster infection is more frequent and severe in the immunocompromised population. Its incidence is significantly higher in this population when compared to immunocompetent individuals. The authors present a case of an 88-year-old man with a history of arterial hypertension and myelodysplastic syndrome. The patient was evaluated in the emergency department (ED) for edema of the frontal facial region with left periorbital involvement and multiple purulent vesicles. He was diagnosed with viral infection by herpes zoster and was prescribed valaciclovir and deflazacort. He returned two days later due to an increase in the lesions affecting the left hemi-cranium, with decreased visual acuity and painless purulent drainage in the ipsilateral eye. The ophthalmological evaluation revealed exuberant edema with associated chemosis and involvement of the cornea of ​​the affected eye. He was hospitalized and began antiviral therapy with intravenous acyclovir and chloramphenicol with topical ganciclovir. There was a progressive resolution of the skin lesions but no reversal of the loss of vision in the affected eye. Herpes zoster infection is more frequent and severe in the immunocompromised population. The clinical presentation is often similar to that of the immunocompetent population; however, it can have exuberant manifestations. The authors emphasize the need for close clinical monitoring of the immunocompromised patient with herpes zoster infection and review the role of corticosteroids when treating this particular population.