Manifestasi oral dan tatalaksana herpes zoster trigeminal pada anak: A rare case report

Abstract

ABSTRAK

Pendahuluan: Herpes zoster trigeminal adalah penyakit yang menyerang saraf trigeminal karena reaktivasi virus varicella zoster (VZV) yang laten di ganglion saraf trigeminal. Prevalensi herpes zoster pada anak usia di bawah 15 tahun termasuk jarang ditemukan, hanya sekitar kurang dari 10% dan yang melibatkan saraf trigeminal sekitar 18-20% kasus. Laporan kasus ini bertujuan untuk melaporkan penatalaksanaan manifestasi oral herpes zoster trigeminal pada anak. Laporan kasus: Seorang anak laki-laki berusia 9 tahun dikonsulkan oleh bagian Ilmu Kesehatan Anak Divisi Infeksi dan Penyakit Tropis ke Klinik Penyakit Mulut dengan keluhan sariawan sakit pada langit-langit dan pipi sisi kanan. Pemeriksaan ekstra oral menemukan lesi vesikel bula dan krusta multiple unilateral pada wajah dan mata sisi kanan dan kelenjar limfa servikal teraba dengan diameter ± 4-5 cm. Intraoral terdapat krusta serous sanguinolenta pada mukosa labial atas kanan dan ulser dengan dasar putih dikelilingi daerah eritema pada palatum dan mukosa bukal kanan dengan keterbatasan membuka mulut. Berdasarkan pemeriksaan penunjang Tzank Smear, diagnosis kerja ditegakkan sebagai herpes zoster yang terjadi pada regio trigeminal V1-V2 kanan yang menunjukkan gambaran multinucleated giant cell. Terapi yang diberikan berupa acyclovir intravena 400 mg/hari setiap 6 jam, kompres bibir menggunakan kasa yang dibasahi NaCl 0,9%, mengoles tipis vaselin album pada bibir yang kering, dan instruksi menjaga kebersihan rongga mulut. Simpulan: Penatalaksanaan herpes zoster trigeminal pada laporan kasus ini menunjukkan hasil yang baik pada mukosa mulut dan wajah, namun tampak jaringan parut pada wajah sisi kanan sampai vermilion bibir kanan atas.

Kata kunci

anak, herpes zoster, saraf trigeminal, virus varicella zoster, laporan kasus

Oral manifestation and management of herpes zoster in children: a rare case report

ABSTRACT

Introduction: Trigeminal herpes zoster is characterized by the reactivation of the latent varicella-zoster virus (VZV) within the trigeminal nerve, leading to inflammation. This disease predominantly affects the trigeminal nerve due to the reactivation of the latent varicella-zoster virus (VZV) in the trigeminal nerve ganglion. Although herpes zoster cases are relatively rare in children under 15, accounting for only approximately 10% of cases, trigeminal nerve involvement is observed in about 18-20%. This case report presents the management approach to addressing the oral manifestations of trigeminal herpes zoster in pediatric patients. Case Report: A 9-year-old boy was referred from the Children's Health Clinic, Division of Infection and Tropical Disease, to the Oral Medicine Clinic due to complaints of painful canker sores on the palate and right cheek. Multiple unilateral vesicles, bullae, and crusts were observed during the extraoral examination on the face and right eye. Additionally, palpable cervical lymph nodes with a diameter of approximately 4-5 cm were detected. A severe sanguinolent crust was noted on the right upper labial mucosa. Furthermore, an ulcer with a white base, surrounded by an erythematous area, was found on the palate and the right buccal mucosa. The patient exhibited limited mouth opening. Following a Tzank Smear investigation, the working diagnosis was established as herpes zoster, manifesting in the right trigeminal region V1-V2. Multinucleated giant cells were observed in the diagnosis. The therapeutic approach consisted of administering intravenous acyclovir at 400 mg/day, with intervals of every 6 hours. The patient was also advised to apply lip compresses using gauze moistened with 0.9% NaCl and thinly smear Vaseline Album onto dry lips. Instructions were also given for maintaining oral hygiene. Conclusion: The treatment of trigeminal herpes zoster, in this case, report yielded favourable outcomes for the oral and facial mucosa; however, residual scar tissue was evident on the right side of the face, extending up to the vermilion of the right upper lip.

Keywords

cildren, herpes zoster, trigeminal nerve, varicella zoster virus, case report